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. 2019 Aug 23:12:235-251.
doi: 10.2147/JAA.S178927. eCollection 2019.

Approaches to the assessment of severe asthma: barriers and strategies

Eleanor C Majellano  1   2 , Vanessa L Clark  1   2 , Natasha A Winter  1   3 , Peter G Gibson  1   4 , Vanessa M McDonald  1   2   4
Affiliations

Approaches to the assessment of severe asthma: barriers and strategies

Eleanor C Majellano et al. J Asthma Allergy. .

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: assessment; asthma; barriers; severe asthma; severity; strategies.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Checklist for the multidimensional assessment of severe asthma. Note: Figure reproduced with permission from the Centre of Excellence in Severe Asthma, originally developed as part of the Severe Asthma Toolkit © (http://www.severeasthma.org.au).
Figure 2
Figure 2
Clinical domains in the phenotyping of severe refractory asthma. Note: Figure reproduced with permission from the Centre of Excellence in Severe Asthma, originally developed as part of the Severe Asthma Toolkit © (http://www.severeasthma.org.au).
Figure 3
Figure 3
Barriers to assessment of severe asthma by stakeholders.
See this image and copyright information in PMC

References

    1. Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, [Updated 2018]. Available from: https://ginasthma.org/wp-content/uploads/2018/04/wms-GINA-2018-report-V1.... Accessed December 2, 2018.
    1. McDonald VM, Hiles SA, Jones KA, Clark VL, Yorke J. Health-related quality of life burden in severe asthma. Med J Aust. 2018;209(2 Suppl):S28–S33. - PubMed
    1. Cordova-Rivera L, Gibson PG, Gardiner PA, Powell H, McDonald VM. Physical activity and exercise capacity in severe asthma: key clinical associations. J Allergy Clin Immunol Pract. 2018;6(3):814–822. doi: 10.1016/j.jaip.2017.09.022 - DOI - PubMed
    1. Foster JM, McDonald VM, Guo M, Reddel HK. “I have lost in every facet of my life”: the hidden burden of severe asthma. Eur Respir J. 2017;50:3. doi: 10.1183/13993003.00711-2017 - DOI - PubMed
    1. Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J. 2015;46(3):622–639. doi: 10.1183/13993003.00853-2015 - DOI - PMC - PubMed