Abstract
Asthma management is in an intriguing phase, with acceptance of asthma as a heterogeneous
condition with different phenotypes and underlying mechanisms and the potential for
personalized asthma care, in parallel with increasing evidence about the population-level
impact of basic strategies to increase access to medicines and improve inhaler technique
and adherence. These changes have been facilitated by a more comprehensive view of
evidence, including both randomized controlled trials with high internal validity
and pragmatic and observational studies with high generalizability to patients in
clinical practice. Evolving concepts of asthma control have led to new approaches
to asthma assessment, recognizing the potential for discordance between symptom control
and risk of exacerbations. A re-evaluation of evidence has also led to substantial
changes in initial treatment of asthma, with the focus moving away from bronchodilator-only
treatment, toward early use of inhaled corticosteroids and novel strategies for mild
asthma. Sputum-guided treatment, where available, is successful in patients with moderate–severe
asthma, but exhaled nitric oxide has not yet satisfied initial assumptions about its
utility for biomarker-guided treatment. New interventions are emerging to improve
adherence with asthma controller medications. A re-evaluation of evidence about written
asthma action plans has led to encouragement of a rapid increase in controller dose,
rather than relying on bronchodilator treatment and oral corticosteroids. Finally,
new models of asthma care are emerging, utilizing the skills of allied health professionals
and recognizing the potential role of telehealth.
Keywords
asthma - self-management - biomarkers
