Journal of Pulmonary Medicine

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Difficult to treat Asthma in adults and adolescents

Difficult asthma signifies a medical situation where an earlier diagnosis of asthma occurs, and asthma-like indications and asthma attacks continue, notwithstanding the high-dose asthma cure treatment. The health of a trivial subset of asthma patients deteriorates, and they are significantly overwhelmed by healthcare expenses, reduced productivity, and low quality of life. Although these patients are <5% of all asthma patients, they are accountable for up to 50% of asthma-related healthcare costs. Patients with difficult-to-control asthma require a meticulous and precise path to their diagnosis and treatment.

The evaluation steps are:

  1. confirmation of the diagnosis of asthma. Furthermore, to exclude alternative airway diseases that mimic asthma and various diagnosis, particularly chronic obstructive pulmonary disease (COPD) and fold dysfunction ("pseudo-asthma").
  2. identification and eradication of triggers that worsen asthma. Besides, there are unknown exasperating factors, including unrecognized allergens, occupational activators, tobacco smoking, tender reaction, dietary additives, drugs, gastro-esophageal reflux, upper airway disease, systemic diseases, that got to establish and avoid/ treat.

Psychological factors also are vital in some patients; however, it is difficult to understand whether these are fundamental or secondary to difficult disease. Most patients with "difficult asthma" need treatment with high-dose inhaled corticosteroids and long-acting inhaled β2-agonists. Despite maximal inhaled therapy, these patients would require frequent bursts or chronic daily therapy with oral corticosteroids. These patients could have "resistant" inflammation with a persistent inflammatory state. (steroid- dependent). In hand-picked patients, extra medical care with leukotriene modifiers or anti-IgE antibody could improve asthma control and may permit tapering of corticosteroids. Rising proof suggests that completely different phenotypes of adverse or therapy-resistant asthma exist. Recognition of those subgroups permits tailored therapy and prevents overmedication in a trial to normalize lung function in patients with irreversible airflow obstruction.

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