Asthma patients adjust their ongoing treatment with corticosteroids too late for worsening

Asthma remains poorly controlled in the majority of patients treated yet continues corticosteroids, probably because they adjust their ill treatment if their symptoms worsen, according to a European study presented at the Congress of the European Society Respiratory (ERS), which was held in Copenhagen.

The INSPIRE study (International Asthma Patient Insight Research) was conducted to try to understand why asthma is well controlled for only about 5% of patients, said Thys van der Molen, University Medical Center Groningen (Netherlands ), in an oral session.

The author and his colleagues interviewed 2,046 adult patients with moderate to severe asthma in eight European countries (Germany, Belgium, Spain, France, Italy, Netherlands, United Kingdom and Sweden) for their attitude in relation to their treatment.

The patients included were followed by a specialist or a generalist and took all continuous treatment with inhaled corticosteroids with or without beta-2 agonist long duration of action (respectively 11% and 33%) or in a fixed combination (56% ).

Scores on the questionnaire asthma control ACQ (Asthma Control Questionnaire) indicate that 49.8% of patients are not controlled (with 15 exacerbations of their symptoms per year) and 20.4% are evil (7 exacerbations per year).

In addition, three-quarters (74%) of patients using beta-2 agonists long-acting daily-a marker of poor disease control, even though they receive continuous treatment with corticosteroids, has said Professor Martyn Patridge, Imperial College & Charing Cross Hospital in London, one of the co-authors.

Curiously, even the well-controlled patients, the ACQ score does not exceed 0.75, reported a worsening of their symptoms seven times a year.

While 90% of asthmatics surveyed say or very confident in their ability to manage their disease themselves without consulting a doctor, they are only 60% know how to identify the signs of an exacerbation.

It also appears that only one patient out of two is watching when it feels good and about 46% of asthmatics are in case of exacerbation.

The behavior most frequently faced with a worsening of asthma is to increase the use of a beta-2 agonist short duration of action, early, from the onset of the first signs. However, these drugs have no effect on inflammation, noted Thys van der Molen.

However, corticosteroids are used when aggravation reached its peak, and they are at a lower dose compared to that used for the beta-2 agonists short duration of action. This usage comes too late, the researcher commented, recalling that corticosteroids can prevent crises.

For the author, this behavior is explained by the fact that patients misunderstand the interest of continued treatment and worsening of symptoms occurs when they seek primarily to relieve them quickly, then using their beta-2 agonist short duration of action.

Moreover, the evidence collected during the investigation underline that on average six days between the first signs of worsening symptoms and peak.

These results show that it is possible for patients to better control their disease by properly adjusting their treatment with inhaled corticosteroid, concluded Thys van der Molen.