Respiratory Medicine
Volume 102, Issue 12 , Pages 1681-1693 , December 2008

Achieving asthma control in practice: Understanding the reasons for poor control

  • John Haughney

      Affiliations

    • Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland, UK
    • Corresponding Author InformationCorresponding author. Tel.: +44 1355 261666; fax: +44 1224 550683.
  • ,
  • David Price

      Affiliations

    • Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland, UK
  • ,
  • Alan Kaplan

      Affiliations

    • Chairperson, Family Physician Airways Group of Canada, Family Physician, 17 Bedford Park Avenue, Richmond Hill, Ontario, Canada L4C 2N9
  • ,
  • Henry Chrystyn

      Affiliations

    • School of Applied Sciences, University of Huddersfield, Huddersfield, West Yorkshire HD1 3DH, UK
  • ,
  • Rob Horne

      Affiliations

    • Centre for Behavioural Medicine, Department of Policy & Practice, The School of Pharmacy, University of London, Mezzanine Floor, BMA House, Tavistock Square, London WC1H 9JP, UK
  • ,
  • Nick May

      Affiliations

    • Healthcare Practice Europe, Middle East, Africa, Hill & Knowlton, 20 Soho Square, London W1A 1PR, UK
  • ,
  • Mandy Moffat

      Affiliations

    • Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland, UK
  • ,
  • Jennifer Versnel

      Affiliations

    • Research & Policy, Asthma UK, Summit House, 70 Wilson Street, London EC2A 2DB, UK
  • ,
  • Eamonn R. Shanahan

      Affiliations

    • Farranfore Medical Centre, Farranfore, Killarney, Co. Kerry, Ireland
  • ,
  • Elizabeth V. Hillyer

      Affiliations

    • Respiratory Research Ltd., Unit 8, Beech Avenue, Taverham, Norwich NR8 6HW, UK
  • ,
  • Alf Tunsäter

      Affiliations

    • Department of Respiratory Medicine & Allergology, University Hospital, 221 85 Lund, Sweden
  • ,
  • Leif Bjermer

      Affiliations

    • Department of Respiratory Medicine & Allergology, University Hospital, 221 85 Lund, Sweden

Received 17 July 2008 ,Accepted 8 August 2008.

References 

  1. Rabe KF, Adachi M, Lai CK, et al. Worldwide severity and control of asthma in children and adults: the global asthma insights and reality surveys. J Allergy Clin Immunol. 2004;114(1):40–47
  2. Partridge MR, van der Molen T, Myrseth SE, Busse WW. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med. 2006;6:13
  3. FitzGerald JM, Boulet LP, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the Reality of Asthma Control (TRAC) study. Can Respir J. 2006;13(5):253–259
  4. Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study. Am J Respir Crit Care Med. 2004;170(8):836–844
  5. Global Initiative for Asthma (GINA) . Global strategy for asthma management and prevention. Available from: <http://www.ginasthma.org>2007;[accessed 26.06.08]
  6. Accordini S, Corsico A, Cerveri I, et al. The socio-economic burden of asthma is substantial in Europe. Allergy. 2008;63(1):116–124
  7. Accordini S, Bugiani M, Arossa W, et al. Poor control increases the economic cost of asthma. A multicentre population-based study. Int Arch Allergy Immunol. 2006;141(2):189–198
  8. Horne R, Price D, Cleland J, et al. Can asthma control be improved by understanding the patient's perspective?. BMC Pulm Med. 2007;7:8
  9. Levy ML, Fletcher M, Price DB, Hausen T, Halbert RJ, Yawn BP. International Primary Care Respiratory Group (IPCRG) Guidelines: diagnosis of respiratory diseases in primary care. Prim Care Respir J. 2006;15(1):20–34
  10. Guilbert TW, Morgan WJ, Zeiger RS, et al. Atopic characteristics of children with recurrent wheezing at high risk for the development of childhood asthma. J Allergy Clin Immunol. 2004;114(6):1282–1287
  11. Bacharier LB, Boner A, Carlsen KH, et al. Diagnosis and treatment of asthma in childhood: a PRACTALL consensus report. Allergy. 2008;63(1):5–34
  12. Panettieri RA, Covar R, Grant E, Hillyer EV, Bacharier L. Natural history of asthma: persistence versus progression – does the beginning predict the end?. J Allergy Clin Immunol. 2008;121(3):607–613
  13. Giraud V, Roche N. Misuse of corticosteroid metered-dose inhaler is associated with decreased asthma stability. Eur Respir J. 2002;19(2):246–251
  14. British Thoracic Society, Scottish Intercollegiate Guidelines Network . British guideline on the management of asthma. Available from: <http://www.sign.ac.uk/guidelines/fulltext/101/index.html>[accessed 26.06.08]
  15. Brocklebank D, Ram F, Wright J, et al. Comparison of the effectiveness of inhaler devices in asthma and chronic obstructive airways disease: a systematic review of the literature. Health Technol Assess. 2001;5(26):1–149
  16. Dolovich MB, Ahrens RC, Hess DR, et al. Device selection and outcomes of aerosol therapy: evidence-based guidelines: American College of Chest Physicians/American College of Asthma, Allergy, and Immunology. Chest. 2005;127(1):335–371
  17. Cochrane MG, Bala MV, Downs KE, Mauskopf J, Ben-Joseph RH. Inhaled corticosteroids for asthma therapy: patient compliance, devices, and inhalation technique. Chest. 2000;117(2):542–550
  18. Al-Showair RA, Pearson SB, Chrystyn H. The potential of a 2Tone Trainer to help patients use their metered-dose inhalers. Chest. 2007;131(6):1776–1782
  19. Lenney J, Innes JA, Crompton GK. Inappropriate inhaler use: assessment of use and patient preference of seven inhalation devices. EDICI. Respir Med. 2000;94(5):496–500
  20. Hesselink AE, Penninx BW, Wijnhoven HA, Kriegsman DM, van Eijk JT. Determinants of an incorrect inhalation technique in patients with asthma or COPD. Scand J Prim Health Care. 2001;19(4):255–260
  21. Nimmo CJ, Chen DN, Martinusen SM, Ustad TL, Ostrow DN. Assessment of patient acceptance and inhalation technique of a pressurized aerosol inhaler and two breath-actuated devices. Ann Pharmacother. 1993;27(7–8):922–927
  22. Newman SP, Pavia D, Garland N, Clarke SW. Effects of various inhalation modes on the deposition of radioactive pressurized aerosols. Eur J Respir Dis. 1982;119:57–65
  23. Shim C, Williams MH. The adequacy of inhalation of aerosol from canister nebulizers. Am J Med. 1980;69(6):891–894
  24. Usmani OS, Biddiscombe MF, Barnes PJ. Regional lung deposition and bronchodilator response as a function of beta2-agonist particle size. Am J Respir Crit Care Med. 2005;172(12):1497–1504
  25. Price D, Thomas M, Mitchell G, Niziol C, Featherstone R. Improvement of asthma control with a breath-actuated pressurised metred dose inhaler (BAI): a prescribing claims study of 5556 patients using a traditional pressurised metred dose inhaler (MDI) or a breath-actuated device. Respir Med. 2003;97(1):12–19
  26. Everard ML, Devadason SG, Le Souef PN. Flow early in the inspiratory manoeuvre affects the aerosol particle size distribution from a Turbuhaler. Respir Med. 1997;91(10):624–628
  27. Pedersen S, Hansen OR, Fuglsang G. Influence of inspiratory flow rate upon the effect of a Turbuhaler. Arch Dis Child. 1990;65(3):308–310
  28. Asthma UK. Using your inhaler. Available from: <http://www.asthma.org.uk/using_your.html>2006;[accessed 26.06.08]
  29. Global Initiative for Asthma (GINA). Instructions for inhaler and spacer use. Available from: <http://www.ginasthma.org/OtherResourcesItem.asp?l1=2&l2=3&intId=30> [accessed 26.06.08].
  30. Annesi-Maesano I, Oryszczyn MP, Raherison C, et al. Increased prevalence of asthma and allied diseases among active adolescent tobacco smokers after controlling for passive smoking exposure. A cause for concern?. Clin Exp Allergy. 2004;34(7):1017–1023
  31. Hylkema MN, Sterk PJ, de Boer WI, Postma DS. Tobacco use in relation to COPD and asthma. Eur Respir J. 2007;29(3):438–445
  32. Price D, Zhang Q, Kocevar VS, Yin DD, Thomas M. Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy. 2005;35(3):282–287
  33. Kerstjens HA, Overbeek SE, Schouten JP, Brand PL, Postma DS. Airways hyperresponsiveness, bronchodilator response, allergy and smoking predict improvement in FEV1 during long-term inhaled corticosteroid treatment. Dutch CNSLD Study Group. Eur Respir J. 1993;6(6):868–876
  34. Chalmers GW, Macleod KJ, Little SA, Thomson LJ, McSharry CP, Thomson NC. Influence of cigarette smoking on inhaled corticosteroid treatment in mild asthma. Thorax. 2002;57(3):226–230
  35. Pedersen B, Dahl R, Karlstrom R, Peterson CG, Venge P. Eosinophil and neutrophil activity in asthma in a one-year trial with inhaled budesonide. The impact of smoking. Am J Respir Crit Care Med. 1996;153(5):1519–1529
  36. Verleden GM, Dupont LJ, Verpeut AC, Demedts MG. The effect of cigarette smoking on exhaled nitric oxide in mild steroid-naive asthmatics. Chest. 1999;116(1):59–64
  37. Tomlinson JE, McMahon AD, Chaudhuri R, Thompson JM, Wood SF, Thomson NC. Efficacy of low and high dose inhaled corticosteroid in smokers versus non-smokers with mild asthma. Thorax. 2005;60(4):282–287
  38. Boulet LP, Lemiere C, Archambault F, Carrier G, Descary MC, Deschesnes F. Smoking and asthma: clinical and radiologic features, lung function, and airway inflammation. Chest. 2006;129(3):661–668
  39. Chaudhuri R, Livingston E, McMahon AD, et al. Effects of smoking cessation on lung function and airway inflammation in smokers with asthma. Am J Respir Crit Care Med. 2006;174(2):127–133
  40. Barnes PJ, Adcock IM, Ito K. Histone acetylation and deacetylation: importance in inflammatory lung diseases. Eur Respir J. 2005;25(3):552–563
  41. Fauler J, Frolich JC. Cigarette smoking stimulates cysteinyl leukotriene production in man. Eur J Clin Invest. 1997;27(1):43–47
  42. International Primary Care Respiratory Group . Tackling the smoking epidemic: IPCRG International guidance on smoking cessation in primary care. Available from: <http://www.theipcrg.org/smoking/index.php>2007;[accessed 26.06.08]
  43. Lazarus SC, Chinchilli VM, Rollings NJ, et al. Smoking affects response to inhaled corticosteroids or leukotriene receptor antagonists in asthma. Am J Respir Crit Care Med. 2007;175(8):783–790
  44. Sarir H, Mortaz E, Karimi K, Johnson M, Nijkamp FP, Folkerts G. Combination of fluticasone propionate and salmeterol potentiates the suppression of cigarette smoke-induced IL-8 production by macrophages. Eur J Pharmacol. 2007;571(1):55–61
  45. Hasani A, Toms N, O'Connor J, Dilworth JP, Agnew JE. Effect of salmeterol xinafoate on lung mucociliary clearance in patients with asthma. Respir Med. 2003;97(6):667–671
  46. Barnes PJ. Reduced histone deacetylase in COPD: clinical implications. Chest. 2006;129(1):151–155
  47. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy. 2008;63(Suppl. 86):8–160
  48. Thomas M. Allergic rhinitis: evidence for impact on asthma. BMC Pulm Med. 2006;6(Suppl. 1):S4
  49. Leynaert B, Bousquet J, Neukirch C, Liard R, Neukirch F. Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey. J Allergy Clin Immunol. 1999;104(2 Pt 1):301–304
  50. Corren J, Adinoff AD, Irvin CG. Changes in bronchial responsiveness following nasal provocation with allergen. J Allergy Clin Immunol. 1992;89(2):611–618
  51. Braunstahl GJ, Kleinjan A, Overbeek SE, Prins JB, Hoogsteden HC, Fokkens WJ. Segmental bronchial provocation induces nasal inflammation in allergic rhinitis patients. Am J Respir Crit Care Med. 2000;161(6):2051–2057
  52. Thomas M, Kocevar VS, Zhang Q, Yin DD, Price D. Asthma-related health care resource use among asthmatic children with and without concomitant allergic rhinitis. Pediatrics. 2005;115(1):129–134
  53. Price DB, Swern A, Tozzi CA, Philip G, Polos P. Effect of montelukast on lung function in asthma patients with allergic rhinitis: analysis from the COMPACT trial. Allergy. 2006;61(6):737–742
  54. Worldwide variation in prevalence of symptoms of asthma, allergic rhinoconjunctivitis, and atopic eczema: ISAAC. The International Study of Asthma and Allergies in Childhood (ISAAC) Steering Committee. Lancet. 1998;351(9111):1225–1232
  55. Price D, Bond C, Bouchard J, et al. International Primary Care Respiratory Group (IPCRG) Guidelines: management of allergic rhinitis. Prim Care Respir J. 2006;15(1):58–70
  56. Crystal-Peters J, Neslusan C, Crown WH, Torres A. Treating allergic rhinitis in patients with comorbid asthma: the risk of asthma-related hospitalizations and emergency department visits. J Allergy Clin Immunol. 2002;109(1):57–62
  57. Rau JL. Determinants of patient adherence to an aerosol regimen. Respir Care. 2005;50(10):1346–1356
  58. Bjermer L. Evidence-based recommendations or “Show me the patients selected and I will tell you the results. Respir Med. 2006;100(Suppl. 1):S17–S21
  59. Herland K, Akselsen JP, Skjonsberg OH, Bjermer L. How representative are clinical study patients with asthma or COPD for a larger “real life” population of patients with obstructive lung disease?. Respir Med. 2005;99(1):11–19
  60. Travers J, Marsh S, Williams M, et al. External validity of randomised controlled trials in asthma: to whom do the results of the trials apply?. Thorax. 2007;62(3):219–223
  61. Valovirta E, Pawankar R. Survey on the impact of comorbid allergic rhinitis in patients with asthma. BMC Pulm Med. 2006;6(Suppl. 1):S3
  62. D'Urzo AD. Inhaled glucocorticosteroid and long-acting beta(2)-adrenoceptor agonist single-inhaler combination for both maintenance and rescue therapy: a paradigm shift in asthma management. Treat Respir Med. 2006;5(6):385–391
  63. O'Byrne PM. Acute asthma intervention: insights from the STAY study. J Allergy Clin Immunol. 2007;119(6):1332–1336
  64. Laforest L, Van Ganse E, Devouassoux G, et al. Asthmatic patients' poor awareness of inadequate disease control: a pharmacy-based survey. Ann Allergy Asthma Immunol. 2007;98(2):146–152
  65. Chetta A, Gerra G, Foresi A, et al. Personality profiles and breathlessness perception in outpatients with different gradings of asthma. Am J Respir Crit Care Med. 1998;157(1):116–122
  66. Bijl-Hofland ID, Cloosterman SG, Folgering HT, Akkermans RP, van Schayck CP. Relation of the perception of airway obstruction to the severity of asthma. Thorax. 1999;54(1):15–19
  67. Malmstrom K, Rodriguez-Gomez G, Guerra J, et al. Oral montelukast, inhaled beclomethasone, and placebo for chronic asthma. A randomized, controlled trial. Montelukast/Beclomethasone Study Group. Ann Intern Med. 1999;130(6):487–495
  68. Zeiger RS, Szefler SJ, Phillips BR, et al. Response profiles to fluticasone and montelukast in mild-to-moderate persistent childhood asthma. J Allergy Clin Immunol. 2006;117(1):45–52
  69. Israel E, Chinchilli VM, Ford JG, et al. Use of regularly scheduled albuterol treatment in asthma: genotype-stratified, randomised, placebo-controlled cross-over trial. Lancet. 2004;364(9444):1505–1512
  70. Wechsler ME, Lehman E, Lazarus SC, et al. beta-Adrenergic receptor polymorphisms and response to salmeterol. Am J Respir Crit Care Med. 2006;173(5):519–526
  71. Bleecker ER, Postma DS, Lawrance RM, Meyers DA, Ambrose HJ, Goldman M. Effect of ADRB2 polymorphisms on response to longacting beta2-agonist therapy: a pharmacogenetic analysis of two randomised studies. Lancet. 2007;370(9605):2118–2125
  72. Drazen JM, Yandava CN, Dube L, et al. Pharmacogenetic association between ALOX5 promoter genotype and the response to anti-asthma treatment. Nat Genet. 1999;22(2):168–170
  73. Currie GP, Lima JJ, Sylvester JE, Lee DK, Cockburn WJ, Lipworth BJ. Leukotriene C4 synthase polymorphisms and responsiveness to leukotriene antagonists in asthma. Br J Clin Pharmacol. 2003;56(4):422–426
  74. Barber N, Parsons J, Clifford S, Darracott R, Horne R. Patients' problems with new medication for chronic conditions. Qual Saf Health Care. 2004;13(3):172–175
  75. World Health Organization . Adherence to long-term therapies: evidence for action. Geneva: World Health Organization; 2003;
  76. Horne R. Compliance, adherence, and concordance: implications for asthma treatment. Chest. 2006;130(1 Suppl.):65S–72S
  77. Spector S. Noncompliance with asthma therapy – are there solutions?. J Asthma. 2000;37(5):381–388
  78. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med. 2000;343(5):332–336
  79. Haynes RB, McDonald H, Garg AX, Montague P. Interventions for helping patients to follow prescriptions for medications. Cochrane Database Syst Rev. 2002;(2):CD000011
  80. Cochrane GM, Horne R, Chanez P. Compliance in asthma. Respir Med. 1999;93(11):763–769
  81. Marinker M, Shaw J. Not to be taken as directed. BMJ. 2003;326(7385):348–349
  82. Horne R, Graupner L, Frost S, Weinman J, Wright SM, Hankins M. Medicine in a multi-cultural society: the effect of cultural background on beliefs about medications. Soc Sci Med. 2004;59(6):1307–1313
  83. Menckeberg TT, Bouvy ML, Bracke M, et al. Beliefs about medicines predict refill adherence to inhaled corticosteroids. J Psychosom Res. 2008;64(1):47–54
  84. Horne R, Weinman J, Hankins M. The Beliefs about Medicines Questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication. Psychol Health. 1999;14(1):1–24
  85. Horne R, Weinman J. Self-regulation and self-management in asthma: exploring the role of illness perceptions and treatment beliefs in explaining non-adherence to preventer medication. Psychol Health. 2002;17(1):17–32
  86. Horne R, Musgrave S, Lee A, Price D. The Minimal Asthma Assessment Tool (MAAT): a new method for prioritising patients for primary care review by identifying poor asthma control and the causes of poor control. Gen Pract Airways Group Annu Conf. 2005;(AB07):16;[Abstract]
  87. Horne R, Price D, Lee A, Musgrave S. ABS004: the concept, prevalence and consequences of low tolerance to ICS in asthma. Prim Care Respir J. 2006;
  88. Partridge MR. Delivering optimal care to the person with asthma: what are the key components and what do we mean by patient education?. Eur Respir J. 1995;8(2):298–305
  89. Picker Institute Europe . Patients make it better. Policy research primer. Available from: <http://www.pickereurope.org/Filestore/Downloads/Policy_Primer_Sept_07_3.pdf>September 2007;[accessed 26.06.08]

PII: S0954-6111(08)00294-1

doi: 10.1016/j.rmed.2008.08.003

Respiratory Medicine
Volume 102, Issue 12 , Pages 1681-1693 , December 2008