Leading experts call for greater action to help asthma patients
Leading experts in asthma have called for greater recognition and action amongst healthcare professionals and patients regarding the current status of asthma management across Europe. The experts, attending a meeting chaired by Professor Stephen Holgate of the University of Southampton, identified key areas for improvement, including: effective control of airway inflammation through the use of more than one anti-inflammatory medication; improved patient education about airway inflammation; and better communication between patients and physicians regarding asthma symptoms, in order to achieve better asthma management and quality of life for many sufferers.
The two-day meeting entitled, "The MetaForum: Improving Asthma Therapy Through More Effective Control of Inflammation," was made possible through an unrestricted educational grant by Merck Sharp & Dohme and brought together more than 40 leading experts in asthma and its management. Participants, including European physicians, educators and patient advocates from 17 countries, gathered to discuss and address the reasons for morbidity, mortality and quality of life for asthma patients despite the availability of clear guidelines and treatment options proven to be effective.
"Opportunities that allow the inclusion of opinion and recommendations from both those responsible for asthma management as well as those affected by it are extremely rare," said MetaForum chair Stephen Holgate, MRC Clinical Professor of Immunopharmacology, Division of Infection, Inflammation and Repair, University of Southampton School of Medicine. "The unique nature of this meeting has been vital in allowing us to establish exactly where and how improvements need to be made in order to treat asthma patients more effectively and help them achieve an ideal quality of life."
Currently, between 100 and 150 million people worldwide have asthma and the number is rising (Reference1). In addition, deaths from asthma have reached 180,000 annually. The economic and social costs of asthma are largely due to uncontrolled disease, and are likely to rise as its prevalence and severity increase (2) and therefore improvement in disease control would substantially reduce costs.
The panel and audience discussion highlighted that: "Scientific evidence, as well as our own experience with patients, shows us that asthma continues to have a major impact on the quality of life experienced by both children and adult sufferers. Guidelines are currently in place to address asthma management, yet asthma sufferers continue to feel the burden of their asthma and their symptoms continue to have a real impact on their life and the quality of their life. As professionals in the asthma arena and representatives for the sufferers we recognise that asthma patients are still not enjoying the best outcome they could have.
"In general parents and patients talking with their healthcare professional do not clearly communicate the continued burden that asthma has on their lives. Additionally, there are gaps in understanding from both the patient and physician side regarding the role and impact of the underlying airway inflammatory component. Such limited understanding and communication does not motivate good practice and often contributes to poor compliance and inadequate symptom control. This in turn leads to lack of satisfaction in patients and may lead to patients' lack of participation in the ongoing disease management process. In addition, although effective treatments exist and are being generally used, many clinicians may not understand all of the facets of asthma management.
"It is clear that the optimal control of airway inflammation is critical and such control will benefit from the application of more than one pharmacological approach. The very nature of the inflammatory response in the airway and our current understandings of the science and the structural changes show that the application of only one therapeutic approach is unlikely to confer complete control of inflammation. Standard therapy with inhaled corticosteroids (ICS) alone does not fully target all mediators of inflammation in the airways of asthmatic patients. In addition, high doses of inhaled steroids are no longer recommended by treatment guidelines, as benefit/ risk ratio diminishes at higher doses. Research has demonstrated that the addition of medication, that include leukotriene receptor antagonists (LTRAs) to inhaled corticosteroids (ICS) is of benefit for the fuller control of inflammation in the airways. (5,6,7)
"The actions that we now need to address as a profession are clear. We need to find ways to improve communication and understanding between physicians and patients and as a result treat asthma more effectively."
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Notes for editors
The MetaForum meeting was held under the auspices of the University of Southampton and was made possible through an unrestricted educational grant by Merck Sharp & Dohme. However, the views expressed during the meeting and the final consensus are independent of the Sponsor.
(1) Bronchial Asthma, WHO Fact Sheet N? 206 Revised January 2000
(2) Barnes PJ, Jonsson B, Klim JB, The costs of asthma. Eur Respir J. 1996 (4):636. Review.
(3) By kind permission of the Treasurer
(4) Structured Review, In Press
(5) Haitchi HM & Holgate ST. New strategies in the treatment and prevention of allergic diseases. Expert Opin. Invest. Drugs 2004(2):13.
(6) Price DB, Herrandez D, Magyar P et al. Randomised controlled trial of montelukast plus inhaled budesonide versus double dose inhaled budesonide in adult patients with asthma. Thorax 2003(58): 211.
(7) Bjemer L, Bisgaard H. Bousquet et al. Montelukast and fluticasone compared with salmeterol and fluticasone in protecting against asthma exacerbations in adults: One year, double blind, randomised, comparative trial. BMJ 2003(322): 891.
The University of Southampton is a leading UK teaching and research institution with a global reputation for leading-edge research and scholarship. Professor Holgate heads a multidisciplinary team of ~50 people at the Southampton General Hospital focused on the underlying mechanisms of asthma and related disorders.