Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2019 Mar 14:15:409-421.
doi: 10.2147/TCRM.S160327. eCollection 2019.

Unmet needs in asthma

Kevin Gruffydd-Jones  1
Affiliations
Review

Unmet needs in asthma

Kevin Gruffydd-Jones. Ther Clin Risk Manag. .

Abstract

Despite advances in the diagnosis and management of asthma, uncontrolled disease is still associated with a substantial mortality and morbidity burden. Patients often overestimate their level of asthma control while also reporting that asthma symptoms affect their quality of life and ability to work or study. There is some evidence of success with primary prevention measures in high-risk children and the secondary prevention of asthma in sensitized individuals or those at risk of developing occupational asthma. There are challenges with diagnosis - with under- and overdiagnosis and misdiagnosis being common - and in the treatment of asthma, despite clear treatment guidelines. In particular, severe asthma presents a huge challenge to the clinician, and its complex and heterogeneous nature warrants a personalized medicine approach to match therapies to individual patients. However, the tools for this are currently lacking in primary care. This article reviews the current unmet need in the diagnosis and clinical management of asthma, and provides an overview of the limitations of current therapies.

Keywords: anticholinergics; asthma management; inhaled corticosteroids; respiratory disease; unmet need; β2-agonists.

PubMed Disclaimer

Conflict of interest statement

Disclosure As a general practitioner, the author has provided a primary care perspective on the review topic. The author has acted as a medical consultant and spoken on behalf of Astra-Zeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma/Napp, Nutricia, Pfizer, and Teva. The author reports no other conflicts of interest in this work.

Figures

Figure 1
Figure 1
Stepwise asthma management in adults, adolescents, and children aged 6–11 years. Notes: *Not for children aged <12 years; **for children aged 6–11 years (preferred step 3 treatment medium-dose ICS); #for patients prescribed BDP/formoterol or BUD/ formoterol maintenance and reliever therapy; ^tiotropium by mist inhaler is an add-on treatment for patients aged ≥12 years with a history of exacerbations. Copyright ©2018 Global Initiative for Asthma. Reproduced with permission from. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2018. Available from: http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/. Abbreviations: ICS, inhaled corticosteroid; BDP, beclomethasone dipropionate; BUD, budesonide; LABA, long-acting β2-agonist; LTRA, leukotriene receptor antagonist; SABA, short-acting β2-agonist.
Figure 2
Figure 2
Stepwise asthma management in children aged ≤5 years. Note: Copyright ©2018 Global Initiative for Asthma. Reproduced with permission from. Global Initiative for Asthma. Global strategy for asthma management and prevention. 2018. Available from: http://ginasthma.org/2018-gina-report-global-strategy-for-asthma-management-and-prevention/. Abbreviations: ICS, inhaled corticosteroid; LTRA, leukotriene-receptor antagonist.
Figure 3
Figure 3
Key areas of unmet need in asthma. Abbreviations: BMI, body mass index; ICS, inhaled corticosteroid.
See this image and copyright information in PMC

References

    1. Beasley R, Semprini A, Mitchell EA. Risk factors for asthma: is prevention possible? Lancet. 2015;386(9998):1075–1085. - PubMed
    1. Global Burden of Disease 2016 Disease and Injury Incidence and Prevalence Collaborators Global, regional, and national incidence, prevalence, and years lived with disability for 328 diseases and injuries for 195 countries, 1990–2016: a systematic analysis for the Global Burden of Disease Study 2016. Lancet. 2017;390:1211–1259. - PMC - PubMed
    1. Bousquet J, Khaltaev N. Global surveillance, prevention and control of chronic respiratory diseases: a comprehensive approach. Geneva: World Health Organization; 2007.
    1. GBD 2013 Mortality and Causes of Death Collaborators Global, regional, and national age-sex specific all-cause and cause-specific mortality for 240 causes of death, 1990–2013: a systematic analysis for the Global Burden of Disease study 2013. Lancet. 2015;385(9963):117–171. - PMC - PubMed
    1. Royal College of Physicians . Why Asthma Still Kills: The National Review of Asthma Deaths (NRAD) London: RCP; 2014.