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Time for a change: personalising asthma treatment

Many people with asthma find it difficult to manage their symptoms and, as with any life-long disease, asthma requires life-long daily treatment[1][2].

Treatment aims to reduce the symptoms patients experience and decrease the number and severity of asthma attacks[2]. For treatment to achieve this, it is vital for people with asthma to understand their condition and why adherence to daily therapies prescribed by their physician is essential[1][2]. Asthma is different for every person, and so, different, personalised treatment approaches are needed[2].

Confusion surrounding mild and moderate asthma treatment

The cornerstone of asthma management for many years has been twofold[2].

  • Controller inhaler – inhaled corticosteroid-containing therapy taken daily to treat inflammation[2].
  • Reliever inhaler – short-acting bronchodilator-based therapy, taken occasionally, when symptoms arise[2].

However, this treatment approach relies on patient adherence to obtain the full benefit[3]. Frequently missed doses can reduce the effectiveness of treatment and while alternative dosing regimens have attempted to reduce the impact of missed dosing, the variety in dosing regimens and treatment options can cause confusion for physicians and patients alike[3][5]. Some people with asthma may have additional conditions that do not allow for alternative dosing regimens[2].

Recent studies have highlighted the difference between physicians and patients in the understanding and expectations around asthma treatment choice5. Some physicians misinterpret how best to prescribe treatments, and many patients do not understand the equally important but distinct roles that maintenance and reliever therapies play[4][5].

Collaboration can cut through the confusion

Patients should feel able to collaborate with their physicians to understand and optimise the best treatment approach for them and their disease[2]. We call this shared decision making (SDM)[2]. It offers the opportunity to develop a more personalised approach to mild and moderate asthma treatment[2].

Personalised therapy uses information unique to each individual patient to create a bespoke treatment plan that is optimised for them[2]. With more treatment options available and an improved understanding of how different treatment options may be more effective for individual patients, personalised therapy is becoming a more realistic option. By building a clear clinical picture for each individual, physicians may be able to make more informed choices on treatment and improve outcomes for their patients[2].

Making it personal

A key part of this more personalised approach is improved SDM. Put simply, SDM is a joint process in which the physician works together with a patient/caregiver to reach a decision about their care based on the scientific evidence and the patient’s individual preferences, beliefs, and values[2][6][7]. Together they would then look at the characteristic hallmarks of the individuals’ condition and based on all of this information would decide the best treatment decisions and agree a plan to improve self-management skills[6].

Empowering individuals

By encouraging honest conversations, the hope is that individuals will feel empowered, more aware of their disease and its management and more engaged in their treatment, leading to improved confidence in their self-care[7].

Ultimately, adoption of this new approach of SDM should lead to every person with asthma gaining access to the most appropriate treatment for them, resulting in better management of asthma for all[2]

References

[1] WHO https://www.who.int/news-room/fact-sheets/detail/asthma. Accessed June 2022

[2] GINA 2022. Available from: https://ginasthma.org/gina-reports/. Accessed June 2022

[3] Barnes et al. J Allergy Clin Immunol 2019;144:1180–6

[4] Chapman KR, et al. Resp Med 2021;186:106524

[5] Chapman KR, et al. Resp Med 2022 e-pub ahead of print

[6] Carmona C, et al. BMJ. 2021 Jun 17;373:n1430

[7] NICE https://www.nice.org.uk/about/what-we-do/our-programmes/nice-guidance/nice-guidelines/shared-decision-making Accessed August 2022

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