Managing difficult-to-control asthma in children can be a challenging task for practitioners. Recent research, specifically the article "The Difficult-to-Control Asthmatic: A Systematic Approach," provides a structured methodology to address this issue effectively. This blog aims to highlight key findings from the research and how they can be implemented to improve asthma management skills.
Confirming Diagnosis and Adherence
The first step in managing difficult-to-control asthma is to confirm the diagnosis. As the research points out, "all that wheezes is not asthma." Practitioners should revisit the diagnosis by obtaining pulmonary function tests and documenting reversible airway obstruction. This helps rule out other conditions like hyperventilation or vocal cord dysfunction that can mimic asthma symptoms.
Ensuring adherence to the medication regimen is equally important. Studies show that even among severe asthmatics, adherence rates can be surprisingly low, ranging from 10% to 46%. Monitoring inhaler use and prescription filling can provide valuable insights into patient compliance.
Identifying Exacerbating Factors
For children with ongoing asthma symptoms, identifying and eliminating exacerbating factors can be crucial. The research highlights the importance of addressing environmental triggers like indoor mold, dust mites, and pet dander. Occupational allergens and irritants should also be considered, especially if symptoms improve during weekends or holidays.
Addressing Concomitant Disorders
Concomitant disorders such as gastroesophageal reflux disease (GERD), allergic rhinitis, and chronic rhinosinusitis can exacerbate asthma symptoms. The study emphasizes the need for a comprehensive evaluation to identify and treat these conditions. For instance, treating GERD with proton pump inhibitors and lifestyle changes can significantly improve asthma control.
Socioeconomic and Psychological Factors
Socioeconomic factors like poverty, access to medical care, and adherence issues play a significant role in asthma management. Psychological factors, including anxiety and depression, can also complicate treatment. Practitioners should be aware of these factors and incorporate strategies to address them, such as patient education and psychological support.
Novel Therapeutic Approaches
While standard therapies like inhaled corticosteroids and ß2 agonists are effective for most patients, about 5% of asthmatics do not respond to these treatments. The research discusses novel strategies like the use of omalizumab for moderate to severe allergic asthma and anti-inflammatory therapies targeting specific immune profiles. These options should be considered for patients who do not respond to conventional therapies.
Conclusion
A systematic approach is essential for managing difficult-to-control asthma. By confirming the diagnosis, ensuring adherence, identifying exacerbating factors, addressing concomitant disorders, and considering socioeconomic and psychological factors, practitioners can significantly improve asthma management outcomes.
To read the original research paper, please follow this link: The Difficult-to-Control Asthmatic: A Systematic Approach
