More and more severe persistent asthma poorly controlled in France

Thousands of asthma, although they represent only a small proportion of all patients with persistent severe disease easily controlled with inhaled corticosteroids, told Reuters Health Prof. Marc Humbert (Antoine hospital Béclère , Clamart, Hauts-de-Seine) in the Days Parisian Allergy, which took place in Paris.

"Asthma is difficult to control with inhaled corticosteroids for only 1-3% of all patients, but on some three million people in France, this fraction induces a large number of consultations and prescriptions," the pulmonologist.

In particular, the study ASUR-1 (asthma emergency) revealed that this persistent asthma poorly controlled, responsible for emergency services use, is linked in most cases to poor adherence, he added . However, he notes, in some cases, asthma is not controlled by appropriate treatment.

"Nevertheless, he says, the technical difficulties related to packaging of anti-asthmatic drugs play a fundamental role in the apparent treatment failure. It is generally accepted that a correct inhalation technique is difficult to obtain even recommendations and appropriate training. Key issues described in the inhalation sessions concern MDIs, especially the poor coordination between the onset of aerosol and inspiration. Educating asthmatic must, therefore imperative to take into account the optimization of taking inhaled treatments at best during learning sessions. "

Cases of severe persistent asthma are characterized by eosinophilia (blood levels of eosinophils than 500/mm3 objectified on NFS), however normal in all allergic patients. "We must then look for possible allergenic permanent stimulus in the home environment and / or professional" advocates specialist. It is, in addition, the clinic must first guide the conduct, he insists.

According to him, the asthmatic patient must analyze the elements of the environment potentially harmful based on information provided by the health care team (results of allergy tests, providing a potentially harmful air contaminants professionals list sulfites in food or some drugs ...).

The lack of improvement after allergen avoidance then suggests rare forms of asthma associated with allergic bronchopulmonary aspergillosis (between 1-6% of severe cases poorly controlled), caused by a fungus (Aspergillus fumigatus) or systemic disease rare (Churg-Strauss syndrome).

"Moreover, continues Professor Humbert, inappropriate drug prescriptions are often the cause of destabilization of asthma. It is therefore important to look taking beta-blockers, aspirin and anti-inflammatory Nonsteroidal. Certain formulations typically be sought (beta-adrenergic blocking agents in the form of eye drops, for example.) In all cases, it is recommended to always report their asthma during an asthma drug prescription. "