Most asthma is not optimally controlled despite availability of effective medications. Why?

Unlike in other chronic diseases such as coronary artery disease and diabetes, comorbidities tend to be overlooked in asthma, possibly because the asthma population is younger and is assumed to be relatively free of comorbidities.

Some commonly overlooked comorbidities linked with asthma include:

- related allergic disorders - food allergy, allergic rhinitis, etc.
- obesity
- depression
- sleep disturbances - OSA, etc.
- adverse events associated with some asthma treatments, particularly long-term corticosteroid use

Poor compliance is a major reason for loss of asthma control. Poor adherence to asthma medications (less than 80%) was seen in 75% of children (JACI, 2011).



Severe asthma - differential diagnosis and management (click to enlarge the image).

If asthma treatment is not working, check DAT:

Diagnosis - not asthma at all (VCD, CF, FBA), asthma plus AR, GERD

Adherence - compliance with medication - 24% of asthma exacerbations are attributable to ICS medication nonadherence (http://goo.gl/1i8ET)

Technique - NEB, HFA with spacer, DPI, etc.

3 C's of care - communication, continuity, concordance (finding common ground) are critical for asthma management (http://goo.gl/8gJM6).

Asthma Inhalers (click to enlarge the image).

References:

Asthma and High Healthcare Use. Gershon AS, Wang C, Guan J. Thorax. 2010;65:612-618, and Medscape.
Severe asthma in children - differential diagnosis and management
24% of asthma exacerbations are attributable to ICS medication nonadherence (http://goo.gl/1i8ET)
Concepts have changed: “compliance” has been replaced by “adherence” but meaning remains the same: 50% of asthmatic patients are poorly adherent to therapy (http://goo.gl/3en5Q).