Approaches to the assessment of severe asthma: barriers and strategies

Abstract

Asthma is a chronic condition with great variability. It is characterized by intermittent episodes of wheeze, cough, chest tightness, dyspnea and backed by variable airflow limitation, airway inflammation and airway hyper-responsiveness. Asthma severity varies uniquely between individuals and may change over time. Stratification of asthma severity is an integral part of asthma management linking appropriate treatment to establish asthma control. Precision assessment of severe asthma is crucial for monitoring the health of people with this disease. The literature suggests multiple factors that impede the assessment of severe asthma, these can be grouped into health care professional, patient and organizational related barriers. These barriers do not exist in isolation but interact and influence one another. Recognition of these barriers is necessary to promote precision in the assessment and management of severe asthma in the era of targeted therapy. In this review, we discuss the current knowledge of the barriers that impede assessment in severe asthma and recommend potential strategies for overcoming these barriers. We highlight the relevance of multidimensional assessment as an ideal approach to the assessment and management of severe asthma.

Keywords:

• asthma
• severe asthma
• severity
• assessment
• barriers
• strategies

Abbreviations

AHR, airway hyper-responsiveness; ICS, inhaled corticosteroids; GINA, Global Initiative for Asthma; LABA, long-acting beta agonist; IgE, immunoglobulin-E; FeNO, exhaled fraction of nitric oxide; ACQ, Asthma Control Questionnaire; ACT, asthma control test; FEV1, forced expiratory volume in one second; FVA, forced vital capacity; RCT, randomized controlled trial; HCP, health care professional; MDT, multidisciplinary team; GP, general practitioner; PCC, patient-centered care; HRQoL, health-related quality of life; PROMs, patient-reported outcome measures.

Disclosure

Dr Vanessa L Clark reports personal fees from Astra Zeneca and grants from National Health and Medical Research Council, outside the submitted work. Professor Peter G Gibson reports grants and personal fees from AstraZeneca, GlaxoSmithKline, Sanofi and Novartis, outside the submitted work. Professor Vanessa McDonald reports grants and personal fees from AstraZeneca, GSK and personal fees from Menarini, outside the submitted work. The authors report no other conflicts of interest in this work.