1. Reducing the hidden burden of severe asthma: Recognition and referrals from primary practice
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Liam G Heaney, Nicola A. Hanania, Marcela Gavornikova, Arnaud Bourdin, Stephen T. Holgate, Nikolaos G. Papadopoulos, David Price, Kenneth R. Chapman, Alan Kaplan, Marc Humbert, David M.G. Halpin, Hypertension pulmonaire : physiopathologie et innovation thérapeutique (HPPIT), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier), Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Division of Infection, Inflammation & Respiratory Medicine, The University of Manchester, Manchester, UK, Allergy Department, 2nd Paediatric Clinic, National & Kapodistrian University of Athens, Athens, Faculty of Medicine, University of Southampton, Southampton, UK, Section of Pulmonary, Critical Care and Sleep Medicine, Baylor College of Medicine, Houston, Texas, USA, Department of Respiratory Medicine, Royal Devon & Exeter Hospital, Royal Devon & Exeter Hospital, Exeter, UK, Asthma and Airway Centre, University Health Network, and University of Toronto, Toronto, Ontario, Canada., Novartis Pharma AG, Basel, Switzerland, Observational and Pragmatic Research Institute, Singapore, and University of Aberdeen, Aberdeen, UK., Family Physician Airways Group of Canada, University of Toronto, Toronto, Ontario, Canada., Queen's University [Belfast] (QUB), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM)-Centre National de la Recherche Scientifique (CNRS), National and Kapodistrian University of Athens (NKUA), Novartis Pharma AG, and MORNET, Dominique
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Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Health Knowledge, Attitudes, Practice ,decision step process ,Referral ,specialist ,[SDV]Life Sciences [q-bio] ,Primary care ,Comorbidity ,Severity of Illness Index ,Medication Adherence ,03 medical and health sciences ,chemistry.chemical_compound ,primary care ,0302 clinical medicine ,Adrenal Cortex Hormones ,medicine ,Immunology and Allergy ,Humans ,030212 general & internal medicine ,Intensive care medicine ,Adverse effect ,Referral and Consultation ,Asthma ,non-corticosteroid therapy ,Primary Health Care ,business.industry ,Inhaler ,Emergency department ,Benralizumab ,medicine.disease ,systemic corticosteroids ,3. Good health ,[SDV] Life Sciences [q-bio] ,030228 respiratory system ,chemistry ,general practitioner ,Pediatrics, Perinatology and Child Health ,Chronic Disease ,referral ,business ,Mepolizumab ,medicine.drug ,Specialization - Abstract
International audience; Since their introduction many decades ago, systemic corticosteroids have become a mainstay treatment for asthma. Despite being a highly effective therapy, corticosteroids can cause significant adverse effects in patients. This results in a "double hit" for some patients as they suffer the burden of disease as well as the burden of treatment-induced morbidity.This article aims to raise awareness of the potential, harmful side effects of prolonged or repeated exposure to systemic corticosteroids in asthma. It also highlights the importance of referral of the appropriate patients with asthma from primary care for specialist assessment once other considerations such as adherence, inhaler technique and co-morbidity have been evaluated. We propose a simple decision step that may help busy primary care physicians and general practitioners to identify patients who could benefit from specialist assessment.Our decision step suggests that a patient with asthma should be reviewed at least once by an asthma specialist if he/she (i) has received ≥2 courses of oral corticosteroids in the previous year; asthma remains uncontrolled despite good adherence and inhaler technique; or (ii) has attended an emergency department or was hospitalised for asthma care.Such referral could facilitate wider access to diagnostic tools, in-depth assessment of confounding comorbidities, and non-corticosteroid-based therapies as needed, which may be unavailable in primary practice.
- Published
- 2020
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