A review of the burden and management of mild asthma in adults — Implications for clinical practice. (June 2019)

• Record Type: Journal Article
• Authors: Mulgirigama, Aruni; Barnes, Neil; Fletcher, Monica; Pedersen, Søren; Pizzichini, Emilio; Tsiligianni, Ioanna
• Is Part Of: Respiratory medicine. Volume 152(2019)
• Page Start: 97
• Page End: 104
• Publication Date: 2019-06
• Subjects: Mild asthma -- Corticosteroids -- Intermittent corticosteroids -- Medication adherence -- Primary healthcare -- Anti-asthmatic agents; ACT Asthma Control Test -- FABA fast-acting beta2-agonist -- FEV1 forced expiratory volume in 1 second -- GINA Global Initiative for Asthma -- HCP healthcare provider -- ICS inhaled corticosteroids -- IPCRG International Primary Care Respiratory Group -- LABA long-acting beta2-agonist -- NAEPP National Asthma Education and Prevention Program -- PCP primary care physician -- QoL quality of life -- RCT randomised controlled trial -- SABA short-acting beta2-agonist -- SIMPLES Smoking, Inhaler technique, Monitoring, Pharmacotherapy, Lifestyle, Education, Support -- START Inhaled Steroid Treatment as Regular Therapy in Early Asthma -- SYGMA Symbicort Given as Needed in Mild Asthma; Chest -- Diseases -- Periodicals; Chest -- Diseases -- Great Britain -- Periodicals; Respiratory organs -- Diseases -- Periodicals; Respiratory Tract Diseases -- Periodicals; Appareil respiratoire -- Maladies -- Périodiques; Thorax -- Maladies -- Périodiques; Appareil respiratoire -- Maladies -- Traitement -- Périodiques; Electronic journals; 616.2
• DOI: 10.1016/j.rmed.2019.04.024
• Languages: English
• ISSNs: 0954-6111

Abstract

Abstract: Mild asthma is present in 50–75% of patients with asthma and is defined by the Global Initiative for Asthma as asthma that can be well controlled with low-intensity treatments (Steps 1 and 2). Despite this definition, 'mild' asthma is often not well controlled in reality, and can have a significant impact on an individual's symptom burden and quality of life. We performed a PubMed literature search to investigate the burden of 'mild' asthma in the lives of patients, including future risk and asthma control, and the current management strategies. While clinical guidelines recommend long-term, daily, low-dose inhaled corticosteroids (ICS) for 'mild' asthma, published data suggest that ICS are often under-prescribed or used intermittently as symptoms arise. Furthermore, patients and physicians tend to overestimate disease control, impacting the accuracy of diagnosing 'mild asthma' and subsequent management. This disconnect may be amplified by miscommunication between patients and physicians, limited objective assessment of control, and differences in guidelines. As with moderate and severe asthma, current evidence supports early initiation of regular ICS in 'mild' asthma to address the underlying inflammation, achieve symptom control and reduce risk of exacerbations. Adherence to ICS treatment is key and can be improved by educating both patients and healthcare professionals. The results of this literature search challenge the term 'mild' asthma and suggest strategies to improve the proactive management of the disease to enable patients to live symptom-free. Highlights: There is a disconnect between asthma perception and guideline classifications. The term 'mild' leads to an underestimation of the impact of mild asthma on patients. Proactive management of patients with mild asthma using regular ICS is important. Education of both patients and physicians may improve the management of mild asthma.