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Review
. 2023 Jun;11(6):573-576.
doi: 10.1016/S2213-2600(22)00490-8. Epub 2023 Jan 27.

A2BCD: a concise guide for asthma management

Marek Lommatzsch  1 , Guy G Brusselle  2 , Mark L Levy  3 , G Walter Canonica  4 , Ian D Pavord  5 , Michael Schatz  6 , Johann Christian Virchow  7
Affiliations
Review

A2BCD: a concise guide for asthma management

Marek Lommatzsch et al. Lancet Respir Med. 2023 Jun.

Abstract

The management of asthma has changed fundamentally during the past two decades. Precise assessment and phenotyping are now required to establish individually targeted treatment with disease-modifying anti-asthmatic drugs (DMAADs). Patients with asthma are often managed by primary care doctors or non-respiratory specialists in secondary care. However, the implementation of complex asthma guidelines in non-specialised care remains a challenge. There is a need for easy-to-understand, concise guides for general practice. In this Viewpoint, we propose a one-page practical guide for asthma management, titled A2BCD, with four components: dual assessment (A2) of asthma (ie, diagnosis and phenotype, plus asthma control and future risks); basic measures (B; eg, education, self-management skills, regular physical activity, and avoidance of asthma triggers); identification and treatment of comorbidities (C) of asthma (eg, chronic rhinosinusitis, obesity, or sleep apnoea); and phenotype-specific, individually targeted treatment with DMAADs (D), including individual inhalation schemes based on inhaled corticosteroids, leukotriene modifiers, biologics, and allergen immunotherapy.

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Conflict of interest statement

Declaration of interests ML has received grants for research or clinical trials, paid to his institution, from AstraZeneca, Deutsche Forschungsgemeinschaft, and GlaxoSmithKline. He has received consulting fees or honoraria for lectures from ALK; Allergopharma; AstraZeneca; Berlin-Chemie; Boehringer Ingelheim; Chiesi; GlaxoSmithKline; HAL Allergy; Leti; Novartis; Merck, Sharp & Dohme; Sanofi; and Teva. He has received travel expenses from AstraZeneca and Novartis. GGB has received research funding, paid to his institution, from Merck, Sharp & Dohme and fees for advisory board membership and lectures from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, and Sanofi. MLL has received consultancy fees from Chiesi, Clement Clarke International, Respiri (Australia), SmartRespiratory, and Teva; fees for advisory board participation from AstraZeneca, Chiesi, GlaxoSmithKline, Novartis, Orion Pharmaceuticals, and Trudel Pharmaceuticals; fees from Chiesi for data safety monitoring board participation; lecture fees from AstraZeneca, Chiesi, Menarini, Novartis, Orion Pharmaceuticals, Soar Beyond, and Teva; conference sponsorship from Chiesi, Orion Pharmaceuticals, and Napp; travel expenses and accommodation support from Orion and the Global Initiative for Asthma; an educational grant from Consorzio Futuro in Ricerca for work as a member of the ADMIT group; accommodation support from NAPP and Chiesi; fees for clinical leadership and mentorship and for assessment and reporting of outcomes from the National Services for Health Improvement; and fees as lead for asthma in developing dashboards for clinical care from Whole Systems Integrated Care, North West London. GWC has received consulting fees from AstraZeneca, Chiesi, GlaxoSmithKline, HAL Allergy, Menarini, Novartis, Regeneron, Sanofi, and Stallergenes; and honoraria for lectures from AstraZeneca, Chiesi, GlaxoSmithKline, HAL Allergy Menarini, Novartis, and Stallergens. IDP has received a research grant from Chiesi. He has received consultancy fees from Almirall; AstraZeneca; Boehringer Ingelheim; Chiesi; Circassia; Dey Pharma; Genentech; GlaxoSmithKline; Knopp Biosciences; Merck; Merck, Sharp & Dohme; Napp Pharmaceuticals; Novartis; Regeneron; RespiVert; Sanofi; Schering-Plough; and Teva. He has received payments to support US Food and Drug Administration approval meetings from GlaxoSmithKline; speaker's fees from Aerocrine, Almirall, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Regeneron, Sanofi, and Teva; scientific meeting sponsorship from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Napp Pharmaceuticals, Regeneron, Sanofi, and Teva; and payment for the organisation of educational events from AstraZeneca, GlaxoSmithKline, Regeneron, Sanofi, and Teva. MS has received research funding, paid to his institution, from ALK; and royalties for educational contributions from UpToDate. MS is Editor-in-Chief of the Journal of Allergy and Clinical Immunology: In Practice and Principal Investigator for the Vaccines and Medications in Pregnancy Surveillance System. JCV has received grants for research from Deutsche Forschungsgemeinschaft; GlaxoSmithKline; and Merck, Sharp & Dohme. He has received consulting fees from Avontec; Boehringer Ingelheim; Chiesi; Essex, Schering-Plough; GlaxoSmithKline; Janssen-Cilag; MEDA; Merck, Sharp & Dohme; Mundipharma; Novartis; Regeneron; Revotar; Roche; Sandoz-Hexal; Sanofi-Aventis; Teva; and UCB, Schwarz-Pharma. He has received honoraria for lectures from AstraZeneca; Avontec; Bayer; Bencard; Bionorica; Boehringer Ingelheim; Chiesi; Essex, Schering-Plough; GlaxoSmithKline; Janssen-Cilag; Leti; MEDA; Merck; Merck, Sharp & Dohme; Mundipharma; Novartis; Nycomed, Altana; Pfizer; Revotar; Sandoz-Hexal; Stallergens; Teva; UCB, Schwarz-Pharma; and Zydus, Cadila. He has received fees for data safety monitoring board participation from Chiesi; and travel support from Sanofi and Boehringer Ingelheim.

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