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Review
. 2022 Jan 25;31(163):210176.
doi: 10.1183/16000617.0176-2021. Print 2022 Mar 31.

Current unmet needs and potential solutions to uncontrolled asthma

William W Busse  1 , Monica Kraft  2
Affiliations
Review

Current unmet needs and potential solutions to uncontrolled asthma

William W Busse et al. Eur Respir Rev. .

Abstract

Despite the availability of effective inhaled therapies, many patients with asthma have poor asthma control. Uncontrolled asthma presents a significant burden on the patient and society, and, for many, remains largely preventable. There are numerous reasons why a patient may remain uncontrolled despite access to therapies, including incorrect inhaler technique, poor adherence to treatment, oversight of triggers and suboptimal medical care. Shared decision-making, good patient-clinician communication, supported self-management, multidisciplinary patient education, new technology and risk stratification may all provide solutions to this major unmet need in asthma. Novel treatments such as biologics could benefit patients' lives, while the investigations into biomarkers, non-Type 2 asthma, treatable traits and disease modification give an exciting glimpse into the future of asthma care.

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Conflict of interest statement

Conflict of interest: W.W. Busse reports consultant fees from AstraZeneca, Genentech, GSK, Novartis, Regeneron Pharmaceuticals Inc., and Sanofi, outside the submitted work. Conflict of interest: M. Kraft reports grants from NIH, Sanofi, ALA, Chiesi and AstraZeneca, consultant fees from Sanofi and AstraZeneca, and Chief Medical Officer fees from RaeSedo LLC, outside the submitted work.

Figures

FIGURE 1
FIGURE 1
Interventions for uncontrolled asthma.
FIGURE 2
FIGURE 2
Key reasons for poor adherence to asthma medication. SABA: short-acting beta-agonist.
FIGURE 3
FIGURE 3
Communication strategies for healthcare professionals. Reproduced from [2] with permission.
FIGURE 4
FIGURE 4
Care pathways and predictors of response for biologics in asthma. CRSwNP: chronic rhinosinusitis with nasal polyposis; CSU: chronic spontaneous urticaria; FENO: fractional exhaled nitric oxide; IgE: immunoglobulin E; IL: interleukin; OCS: oral corticosteroid; TSLP: thymic stromal lymphopoietin. #In randomised control trials, there was a greater decrease in exacerbations in patients with blood eosinophil levels of ≥260 cells·μL−1 (omalizumab versus placebo) [115, 127]. The higher the eosinophil level, the higher the expected impact. §Anti-TSLP not approved in patients with asthma at time of publication. Reproduced and modified from [77].
See this image and copyright information in PMC

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