Optimal Asthma Control: Time for a New Target
Abstract
The stepwise approach to pharmacological treatment in adult asthma mandates that asthma treatment is progressively stepped up to achieve symptom control and reduce the risk of exacerbations and stepped down after a period of prolonged control. This review proposes that in adults without good asthma control, well-controlled asthma can only be achieved in approximately 70% of patients across the strata of severity, and only if there is a progressive increase in inhaled corticosteroid/long-acting β2 agonist therapy to a maintenance inhaled corticosteroid dose that causes the same magnitude of systemic side effects as oral prednisone at a 5-mg daily dose. Another consideration is that in a person with asthma, there are numerous overlapping disorders that can present with symptoms indistinguishable from asthma, comorbidities that contribute to poor control and lifestyle/environmental factors that require treatment in their own right and that if specifically managed might lead to better outcomes. The disparity between patients’ perceptions and guideline assessment of control may be due to partially controlled asthma being associated with near-maximal levels of quality of life, with minimal impairment. Finally, it is widely assumed that asthma symptom control equates to elimination of risk of asthma attacks, an assumption that may not apply to many patients, particularly those with more severe asthma. We propose that further research be undertaken to determine the optimal levels of asthma control and the potential value of different treatment targets, such as control of type-2 airway inflammation, that can be achieved with currently available treatment, based on efficacy, side effects, and cost.
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Most asthma patients experience ongoing symptoms and fail to achieve ultimate control despite access to appropriate treatments.
“Access to appropriate treatments may lead to wellcontrolled asthma; however, evidence shows that most patients experience ongoing symptomsandfailtoachieveultimate control (4).”
From The Effect of Group Acceptance and Commitment Therapy on the Management of Asthma: A Randomized Clinical Trial (2022) · cites this paper as [4]
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Zargar, F., Rabiei, M., Naderi, Z., & Tarrahi, M. J. (2022) · Iranian Journal of Psychiatry and Behavioral Sciences · doi:10.5812/ijpbs.114534
- Authors
- Beasley, R., Braithwaite, I., Semprini, A., Kearns, C., Weatherall, M., & Pavord, I. D.
- Affiliations
- Victoria University of Wellington (NZ)
- Medical Research Institute of New Zealand (NZ)
- Capital and Coast District Health Board (NZ)
- National Institute for Health and Care Research (GB)
- Corresponding author
- Beasley, Richard
- Venue
- American Journal of Respiratory and Critical Care Medicine
- Publisher
- Oxford University Press (OUP)
- Published
- 2020-06
- Volume
- 201
- Issue
- 12
- Pages
- 1480-1487
- ISSN
- 1073-449X (ISSN-L)
- 1535-4970
- OpenAlex
- W2999959981
- Cited by
- 55
- References
- 30
- Citations by year
- 2026: 5 · 2025: 7 · 2024: 7 · 2023: 7 · 2022: 9 · 2021: 12 · 2020: 7
- FWCI
- 1.12
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- American Journal of Respiratory and Critical Care Medicine (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Asthma and respiratory diseases
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Chronic Obstructive Pulmonary Disease (COPD) Research
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Occupational exposure and asthma
- Keywords
- asthma control, inhaled corticosteroids, long-acting beta2-agonists, asthma severity, comorbidities, quality of life, asthma exacerbations, type 2 airway inflammation, systemic corticosteroid side effects, adult asthma
- MeSH terms
- Administration, Inhalation, Administration, Oral, Adrenal Cortex Hormones, Asthma, Humans, Quality of Life, Severity of Illness Index, Practice Guidelines as Topic, Anti-Asthmatic Agents, Adrenergic beta-2 Receptor Agonists
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