Patient perspectives in the management of asthma: improving patient outcomes through critical selection of treatment options

Figures & data

Table 1 Effects of glucocorticoids on the pathogenic mechanisms of airway inflammation

Inhibit the production of proinflammatory cytokines Reduce the number of mast cells, eosinophils, and other inflammatory cells of the airways Increase the beta2-adrenergic receptor responsiveness of the airways to sympathomimetic agents Modulate the synthesis of IgE in allergic-atopic subjects Interfere with the biosynthesis of eicosanoids Reduce nitric oxide production Inhibit neurogenic inflammation Prevent the activation and migration of inflammatory cells Reduce vasodilation of the microcirculation and thus the edema by plasma exudation Reduce the production of mucus

Figure 1 Schematic of the bronchial tree with emphasis on the peripheral district, which is the main target of anti-asthmatic treatment.

Table 2 Description of the main properties of different devices

Type	Advantages	Limitations
Pressurized metered dose inhaler (pMDI)	Portable	Need for coordination
	Accepted in emergencies	Not suitable for children
	Used for different compounds	High deposition in the pharynx
Dry powder inhaler (DPI)	Portable	Need for high inspiratory flow
	Actuation by inhalation	Not suitable for children
	Less need for coordination	Not acceptable in emergencies
	Used for different compounds	Negative effect of humidity on the drug
		Variable deposition in the pharynx
Nebulizer	No need for coordination	Difficult to carry
	No need for maximal inspiratory maneuvers	Long inhalation sessions
		Hygiene and maintenance issues
	Suitable for all ages	Possible degradation of the active drug (ultrasound)
	Accepted in emergency situations
	Allows for oxygen supplementation	Variation in the amount of inhaled drug cost

Table 3 Consequences of nonadherence

Low control of symptoms Negative effects on quality of life Loss of working or school-days Increase in disability Progression of the disease Unjustified use of drugs, often with relevant side effects More unplanned medical examinations More frequent hospitalizations