Asthma management is increasingly becoming more personalized. Here are 6 ways you can help personalize treatment for your patients with asthma that is severe or difficult to control.
One of the best ways to personalize patients’ asthma treatment is to identify their endotype and phenotype. A patient’s “endotype” is the molecular pathway driving the disease, whereas the “phenotype” is its observable characteristics.
There are 2 broad categories of asthma endotypes: T2-high and non-T2 asthma. T2 inflammation is generally caused by allergens and is stimulated by type-2 inflammatory cytokines, including IL-4, IL-5, and IL-13. On the other hand, non-T2 asthma is generally brought on by viruses and other irritants causing a downstream release and activation of neutrophils through Th1 and Th17 cytokines. We can identify if a patient has T2-high or non-T2 asthma based on their phenotype, clinical characteristics, and biomarkers, which you can learn more about here. T2-high asthma phenotypes include atopic/early-onset allergic asthma, late-onset/eosinophilic asthma, and aspirin-exacerbated respiratory disease. Non-T2 asthma phenotypes include non-atopic asthma, smokers’ asthma, obesity-related asthma, and elderly asthma.
Equally important is quantifying how controlled the patient’s asthma is. You can do this by asking how many days a week they are having symptoms: Do their symptoms wake them up at night? How many times a week are they using their rescue inhaler? Are they having symptoms of cough, chest tightness, and shortness of breath? It is also a good idea to assess if outside factors are impacting their asthma control: Do they have correct inhaler technique? If they have multiple inhalers, are they using them at the correct times? Are they smoking or vaping? Do they have allergens at home they are constantly being exposed to?
Clinicians need to assess the impact asthma is having on the quality of a patient’s life. Are they missing work due to their symptoms? Are they missing school? Are they limiting their involvement in sports or not going out with friends? For practical tips from a multidisciplinary expert panel of healthcare professionals about assessing and improving quality of life in an asthma case study, click here.
Education regarding allergen avoidance is also very helpful. Although patients may be aware of their triggers, many employ avoidance strategies that are incomplete. A comprehensive approach to allergen avoidance needs to be emphasized, particularly for those allergic to pet dander, as a lot of data now indicate that cat and dog dander have become “community allergens.” Many people are walking around with the allergen on their clothing and shedding it as they go through the day. So, even in public places where there may be no cats and dogs in sight, patients who are sensitized to cat or dog allergens may still have clinically significant exposure.
Patients with severe or difficult-to-control asthma can find that if they have other atopic conditions, getting those under control can help with their asthma. These include chronic rhinosinusitis, allergic rhinitis, eosinophilic esophagitis, atopic dermatitis, and others. Developing a strong multidisciplinary relationship with allergists/immunologists, pulmonologists, dermatologists, gastroenterologists, otolaryngologists, pediatricians, and primary care clinicians is key to optimizing the management of comorbid atopic conditions. You can learn more about the multidisciplinary and interprofessional management of atopic comorbidities in an asthma case study here.
Finally, after starting a new treatment plan, optimize your follow-up strategy by asking the patients to demonstrate how they are taking their medication, when, and if they are missing any doses. If they are, why are they missing them? Are they having difficulty administering their injections? Are they embarrassed to use their inhaler in public? Are there family dynamics at play? Are they having side effects? Investigate those barriers and have a conversation with the patient on how to overcome them.
You also want to assess if they have improved on the new medication plan by reassessing asthma control. Are they still having exacerbations? How often are they waking up at night now? How often are they using their rescue inhaler now? If they are on chronic steroids, can the dose be decreased now? Has their lung function improved?
These are just a few of the ways you can help personalize therapy for your patients with asthma. Always keep the conversation open between you and your patients so you can assess what is important for them, what is working for them, and, if changes need to be made, what type of changes are best for them.
For more, check out the following CE activities, expiring soon!
Challenging Cases in Asthma: Optimizing Biologics in Adults
Challenging Cases in Asthma: Improving Quality of Life
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