Emerging Concepts in Evidence-Based Asthma Management

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Abstract

Asthma management is in an intriguing phase, with acceptance of asthma as a heterogeneous condition with different phenotypes and underlying mechanisms and the potential for personalized asthma care, in parallel with increasing evidence about the population-level impact of basic strategies to increase access to medicines and improve inhaler technique and adherence. These changes have been facilitated by a more comprehensive view of evidence, including both randomized controlled trials with high internal validity and pragmatic and observational studies with high generalizability to patients in clinical practice. Evolving concepts of asthma control have led to new approaches to asthma assessment, recognizing the potential for discordance between symptom control and risk of exacerbations. A re-evaluation of evidence has also led to substantial changes in initial treatment of asthma, with the focus moving away from bronchodilator-only treatment, toward early use of inhaled corticosteroids and novel strategies for mild asthma. Sputum-guided treatment, where available, is successful in patients with moderate-severe asthma, but exhaled nitric oxide has not yet satisfied initial assumptions about its utility for biomarker-guided treatment. New interventions are emerging to improve adherence with asthma controller medications. A re-evaluation of evidence about written asthma action plans has led to encouragement of a rapid increase in controller dose, rather than relying on bronchodilator treatment and oral corticosteroids. Finally, new models of asthma care are emerging, utilizing the skills of allied health professionals and recognizing the potential role of telehealth.

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