Best practice advice for asthma exacerbation prevention and management in primary care: an international expert consensus

Best practice advice for asthma exacerbation prevention and management in primary care: an international expert consensus

  • Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention. Available from: www.ginasthma.org (2024).

  • Castillo, J. R., Peters, S. P. & Busse, W. W. Asthma exacerbations: pathogenesis, prevention, and treatment. J. Allergy Clin. Immunology: Pract. 5, 918–927 (2017).

    Google Scholar 

  • Skolnik, N. Use of ICS and fast-acting bronchodilators in asthma: past, present, and future. J. Fam. Pract. 72 (2023).

  • Cao, Y. et al. Global trends in the incidence and mortality of asthma from 1990 to 2019: an age-period-cohort analysis using the global burden of disease study 2019. Front Public Health 10, 1036674 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Most Recent National Asthma Data | CDC. Accessed March 31, 2023. January 9, 2023

  • Mannino, D. M. et al. Surveillance for Asthma—United States, 1980-1999. Morbidity Mortal. Wkly. Rep. 51, 1–13 (2002).

    Google Scholar 

  • Suruki, R. Y., Daugherty, J. B., Boudiaf, N. & Albers, F. C. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm. Med. 17, 74 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Wu, T. D., Brigham, E. P. & McCormack, M. C. Asthma in the primary care setting. Med. Clin. North Am. 103, 435–452 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Fletcher, M. J. et al. Improving primary care management of asthma: do we know what really works? NPJ Prim. Care Respir. Med. 30, 29 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Cloutier, M. M. et al. 2020 focused updates to the asthma management guidelines: a report from the National Asthma Education and prevention program coordinating committee expert panel working group. J. Allergy Clin. Immunol. 146, 1217–1270 (2020). Expert Panel Working Group of the National Heart, Lung, and Blood Institute (NHLBI) administered and coordinated National Asthma Education and Prevention Program Coordinating Committee (NAEPPCC).

    Article 
    PubMed 

    Google Scholar 

  • Yang, C. L. et al. Canadian Thoracic Society 2021 Guideline update: diagnosis and management of asthma in preschoolers, children and adults. Can. J. Respir. Crit. Care Sleep. Med. 5, 348–361 (2021).

    Google Scholar 

  • Nakamura, Y. et al. Japanese guidelines for adult asthma 2020. Allergol. Int. 69, 519–548 (2020).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guideline for the primary care management of asthma. Published online September 2019. Accessed January 30. (2024).

  • National Asthma Council Australia. Australian Asthma Handbook. Accessed January 31. (2024).

  • EPR3. “Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma (EPR2 1997)”. NIH Publication No. 97-4051. Bethesda, MD: U.S. Department of Health and Human Services; National Institutes of Health; National Heart, Lung, and Blood Institute; National Asthma Education and Prevention Program, 2007. Accessed May 12. (2023).

  • Greenblatt, M., Galpin, J. S., Hill, C., Feldman, C. & Green, R. J. Comparison of doctor and patient assessments of asthma control. Respir. Med. 104, 356–361 (2010).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Lugogo, N., Skolnik, N., Jiang, Y. A Paradigm Shift for Asthma Care. J. Fam. Pract. 71 (2022).

  • Murphy, K. R. et al. Development of the Asthma Impairment and Risk Questionnaire (AIRQ): a composite control measure. J. Allergy Clin. Immunol. Pract. 8, 2263–2274.e5 (2020).

    Article 
    PubMed 

    Google Scholar 

  • Beuther, D. et al. Assessing the Asthma Impairment and Risk Questionnaire’s ability to predict exacerbations. In: Monitoring Airway Disease. European Respiratory Society PA3714 (2021).

  • Chipps, B. E. et al. Assessing construct validity of the asthma impairment and risk questionnaire using a 3-month exacerbation recall. Ann. Allergy Asthma Immunol. S1081-1206, 00081–00083 (2022).

    Google Scholar 

  • Yawn, B. Introduction of Asthma APGAR tools improve asthma management in primary care practices. JAA. Published online:1. August (2008).

  • Yawn, B. P. et al. Use of Asthma APGAR tools in primary care practices: a cluster-randomized controlled trial. Ann. Fam. Med. 16, 100–110 (2018).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Nathan, R. A. et al. Development of the asthma control test: a survey for assessing asthma control. J. Allergy Clin. Immunol. 113, 59–65 (2004).

    Article 
    PubMed 

    Google Scholar 

  • Schatz, M. et al. The minimally important difference of the Asthma Control Test. J. Allergy Clin. Immunol. 124, 719–723.e1 (2009).

    Article 
    PubMed 

    Google Scholar 

  • Juniper, E. F., O’Byrne, P. M., Guyatt, G. H., Ferrie, P. J. & King, D. R. Development and validation of a questionnaire to measure asthma control. Eur. Respir. J. 14, 902–907 (1999).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Azevedo, P. et al. Control of Allergic Rhinitis and Asthma Test (CARAT): dissemination and applications in primary care. Prim. Care Respir. J. 22, 112–116 (2013).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Ramsey, R. R. et al. A systematic evaluation of asthma management apps examining behavior change techniques. J. Allergy Clin. Immunol. Pract. 7, 2583–2591 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Zhang, O., Minku, L. L. & Gonem, S. Detecting asthma exacerbations using daily home monitoring and machine learning. J. Asthma 58, 1518–1527 (2021).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Dabbs, W., Bradley, M. H. & Chamberlin, S. M. Acute asthma exacerbations: management strategies. Am. Fam. Phys. 109, 43–50 (2024).

    Google Scholar 

  • Plaza Moral, V. et al. GEMA 5.3. Spanish guideline on the management of asthma. Open Respir. Arch. 5, 100277 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Chan-Yeung, M., Chang, J. H., Manfreda, J., Ferguson, A. & Becker, A. Changes in peak flow, symptom score, and the use of medications during acute exacerbations of asthma. Am. J. Respir. Crit. Care Med. 154, 889–893 (1996).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Agusti, A. et al. Treatable traits: toward precision medicine of chronic airway diseases. Eur. Respir. J. 47, 410–419 (2016).

    Article 
    PubMed 

    Google Scholar 

  • Aldridge, R. E. et al. Effects of terbutaline and budesonide on sputum cells and bronchial hyperresponsiveness in asthma. Am. J. Respir. Crit. Care Med. 161, 1459–1464 (2000).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Tattersfield, A. E. et al. Exacerbations of asthma: a descriptive study of 425 severe exacerbations. The FACET International Study Group. Am. J. Respir. Crit. Care Med 160, 594–599 (1999).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Ghebre, M. A. et al. Severe exacerbations in moderate-to-severe asthmatics are associated with increased pro-inflammatory and type 1 mediators in sputum and serum. BMC Pulm. Med. 19, 144 (2019).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Shrestha Palikhe, N. et al. Th2 cell markers in peripheral blood increase during an acute asthma exacerbation. Allergy 76, 281–290 (2021).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Miller, M. K., Lee, J. H., Miller, D. P. & Wenzel, S. E. TENOR Study Group. Recent asthma exacerbations: a key predictor of future exacerbations. Respir. Med 101, 481–489 (2007).

    Article 
    PubMed 

    Google Scholar 

  • AsthmaStats: Uncontrolled Asthma among Adults, 2019 | CDC. August 12, 2022. Accessed March 31. (2023).

  • AsthmaStats: Uncontrolled Asthma Among Children With Current Asthma, 2018–2020 | CDC. August 22, 2022. Accessed March 31. (2023).

  • Bleecker, E. R., Gandhi, H., Gilbert, I., Murphy, K. R. & Chupp, G. L. Mapping geographic variability of severe uncontrolled asthma in the United States: Management implications. Ann. Allergy Asthma Immunol. 128, 78–88 (2022).

    Article 
    PubMed 

    Google Scholar 

  • Ding, B. & Small, M. Disease burden of mild asthma: findings from a cross-sectional real-world survey. Adv. Ther. 34, 1109–1127 (2017).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Royal College of Physicians. Why asthma still kills; The National Review of Asthma Deaths (NRAD). RCP London. August 11, 2015. Accessed April 22. (2024).

  • Engelkes, M., Janssens, H. M., de Jongste, J. C., Sturkenboom, M. C. J. M. & Verhamme, K. M. C. Medication adherence and the risk of severe asthma exacerbations: a systematic review. Eur. Respir. J. 45, 396–407 (2015).

    Article 
    PubMed 

    Google Scholar 

  • Vähätalo, I. et al. 12-year adherence to inhaled corticosteroids in adult-onset asthma. ERJ Open Res. 6, 00324–02019 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Vähätalo, I. et al. Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma. ERJ Open Res. 7, 00715–02020 (2021).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Paracha, R. et al. Asthma medication adherence and exacerbations and lung function in children managed in Leicester primary care. npj Prim. Care Respir. Med 33, 12 (2023).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Papi, A. et al. Albuterol–Budesonide fixed-dose combination rescue inhaler for asthma. N. Engl. J. Med. 386, 2071–2083 (2022).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Chipps, B. et al. Albuterol-budesonide Fixed-dose Combination (FDC) inhaler as-needed reduces progression from symptomatic deterioration to severe exacerbation in patients with moderate-to-severe asthma: analysis from MANDALA. J. Allergy Clin. Immunol. 151, AB16 (2023).

    Article 

    Google Scholar 

  • Israel, E. et al. Reliever-triggered inhaled glucocorticoid in black and Latinx adults with asthma. N. Engl. J. Med. Published online February 26. (2022).

  • Beasley, R. et al. Evaluation of Budesonide-Formoterol for maintenance and reliever therapy among patients with poorly controlled asthma: a systematic review and meta-analysis. JAMA Netw. Open 5, e220615 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Janjua, S. et al. Interventions to improve adherence to pharmacological therapy for chronic obstructive pulmonary disease (COPD). Cochrane Database Syst. Rev. 9, CD013381 (2021).

    PubMed 

    Google Scholar 

  • Rootmensen, G. N., Van Keimpema, A. R. J., Jansen, H. M. & De Haan, R. J. Predictors of incorrect inhalation technique in patients with asthma or COPD: a study using a validated videotaped scoring method. J. Aerosol. Med. Pulm. Drug Deliv. 23, 323–328 (2010).

    Article 
    PubMed 

    Google Scholar 

  • Denholm, R., van der Werf, E. T. & Hay, A. D. Use of antibiotics and asthma medication for acute lower respiratory tract infections in people with and without asthma: retrospective cohort study. Respir. Res. 21, 4 (2020).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Crompton, G. K. et al. The need to improve inhalation technique in Europe: a report from the aerosol drug management improvement team. Respir. Med. 100, 1479–1494 (2006).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Waljee, A. K. et al. Short term use of oral corticosteroids and related harms among adults in the United States: population based cohort study. BMJ Published online April 12:j1415. (2017).

  • Price, D. B. et al. Adverse outcomes from initiation of systemic corticosteroids for asthma: long-term observational study. J. Asthma Allergy 11, 193–204 (2018).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Heatley, H. et al. Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma. Thorax Published online December 27:thorax-2022-219642. (2022).

  • Hew, M. et al. Cumulative dispensing of high oral corticosteroid doses for treating asthma in Australia. Med. J. Aust. 213, 316–320 (2020).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Bleecker, E. R. et al. Systemic corticosteroids in asthma: a call to action from World Allergy Organization and Respiratory Effectiveness Group. World Allergy Organ J. 15, 100726 (2022).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • O’Byrne, P. M. et al. Inhaled combined budesonide-formoterol as needed in mild asthma. N. Engl. J. Med 378, 1865–1876 (2018).

    Article 
    PubMed 

    Google Scholar 

  • O’Byrne, P. M. et al. Effect of a single day of increased as-needed budesonide–formoterol use on short-term risk of severe exacerbations in patients with mild asthma: a post-hoc analysis of the SYGMA 1 study. Lancet Respir. Med. 9, 149–158 (2021).

    Article 
    PubMed 

    Google Scholar 

  • Bateman, E. D. et al. As-Needed Budesonide–Formoterol versus Maintenance Budesonide in Mild Asthma. N. Engl. J. Med. 378, 1877–1887 (2018).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • O’Byrne, P. M. et al. Budesonide/formoterol combination therapy as both maintenance and reliever medication in asthma. Am. J. Respir. Crit. Care Med. 171, 129–136 (2005).

    Article 
    PubMed 

    Google Scholar 

  • Scicchitano, R. et al. Efficacy and safety of budesonide/formoterol single inhaler therapy versus a higher dose of budesonide in moderate to severe asthma. Curr. Med. Res. Opin. 20, 1403–1418 (2004).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Rabe, K. F. et al. Budesonide/formoterol in a single inhaler for maintenance and relief in mild-to-moderate asthma: a randomized, double-blind trial. Chest 129, 246–256 (2006).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Calhoun, W. J. et al. Comparison of physician-, biomarker-, and symptom-based strategies for adjustment of inhaled corticosteroid therapy in adults with asthma: the BASALT randomized controlled trial. JAMA 308, 987–997 (2012).

    Article 
    CAS 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Panettieri, R. A. et al. Non-genomic effects of glucocorticoids: an updated view. Trends Pharm. Sci. 40, 38–49 (2019).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Alangari, A. A. Genomic and non-genomic actions of glucocorticoids in asthma. Ann. Thorac. Med 5, 133–139 (2010).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Dubaybo, B. A. The care of asthma patients in communities with limited resources. Res Rep. Trop. Med 12, 33–38 (2021).

    PubMed 
    PubMed Central 

    Google Scholar 

  • Nanda, A. et al. Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee. J. Allergy Clin. Immunol. 151, 869–880 (2023).

    Article 
    PubMed 

    Google Scholar 

  • Persaud, Y. K. Using telemedicine to care for the asthma patient. Curr. Allergy Asthma Rep. 22, 43–52 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Guevara, J. P., Wolf, F. M., Grum, C. M. & Clark, N. M. Effects of educational interventions for self management of asthma in children and adolescents: systematic review and meta-analysis. BMJ 326, 1308–1309 (2003).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • Gibson, P. G. et al. Self-management education and regular practitioner review for adults with asthma. Cochrane Database Syst. Rev. CD001117. (2023).

  • Wilson, S. R. et al. Shared treatment decision making improves adherence and outcomes in poorly controlled asthma. Am. J. Respir. Crit. Care Med. 181, 566–577 (2010).

    Article 
    PubMed 

    Google Scholar 

  • Lugogo, N. et al. Real-world patterns and implications of short-acting β2-agonist use in patients with asthma in the United States. Ann. Allergy, Asthma Immunol. 126, 681–689.e1 (2021).

    Article 
    CAS 
    PubMed 

    Google Scholar 

  • Partridge, M. R., van der Molen, T., Myrseth, S. E. & Busse, W. W. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm. Med. 6, 13 (2006).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

  • McDonald, V. M., Harrington, J., Clark, V. L. & Gibson, P. G. Multidisciplinary care in chronic airway diseases: the Newcastle model. ERJ Open Res. 8, 00215–02022 (2022).

    Article 
    PubMed 
    PubMed Central 

    Google Scholar 

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