An estimated 24 percent of exacerbations and 60 percent of asthma-related hospitalizations are attributable to poor adherence
There are 300 million people in the world who suffer from asthma, 30 million in Europe and in Italy there are an estimated 4 million and 700 thousand adult patients. a chronic inflammatory disease of the respiratory tract, characterized by moments of exacerbation that respond to an external stimulus that produce bronchospasm, narrowing of the bronchi, mucus with the consequence of difficulty breathing and bringing oxygen to the organs. The disease occurs substantially in childhood linked to allergies and in the 18-25 age range when respiratory infections are the cause. In both cases, atopy, ie genetic hypersensitivity to some allergens present in the environment, is the main cause. For patients who cannot control their asthma on a dual combination of inhaled corticosteroid and inhaled long-acting bronchodilator (ICS+LABA), and who are at risk of frequent respiratory crises and worsening lung function from it is hardly possible to resort to an extrafine triple combination BDP/FF/G which places three active ingredients in a single inhaler: an inhaled corticosteroid/ICS (beclomethasone dipropionate, BDP), a long-acting beta2-agonist bronchodilator/ LABA (formoterol fumarate, FF) and a long-acting muscarinic antagonist/LAMA (glycopyrronium, G). Inhaled corticosteroids reduce airway inflammation and reduce the risk of exacerbations; bronchodilators, on the other hand, act on bronchial obstruction, reducing symptoms. Asthmatic patients who do not achieve adequate disease control with the ICS/LABA combination can use, with a single inhalation device, triple therapy or the combination of ICS/LABA/LAMA, with an enhancement of therapeutic efficacy, he declares Paola Rogliani, Full Professor of Diseases of the respiratory system, University of Rome Tor Vergata. The triple fixed combination represents an optimization of inhalation therapy in patients with uncontrolled asthma, with an impact in reducing severe exacerbations and improving lung function. Another characteristic of the triple association is the extra-fine formulation characterized by small inhaled particles: it guarantees us the deposition of the active ingredients with a wide distribution that also reaches the peripheral airways, involved with structural and functional anomalies in patients with asthma and uncontrolled asthma .
The triggering factors of an asthmatic crisis are primarily viral infections of the respiratory tract, but also exposure to allergens present in the environment such as mites, pollen, dust in the professional field, explains Francesco Blasi, full professor of diseases of the respiratory system, University of Milan. An asthma attack represents an acute worsening of symptoms and respiratory function. If the disease is not controlled, the exacerbations can recur over time and can also be very serious, causing considerable discomfort for the patient and even causing access to the emergency department or hospitalization. When asthma is controlled thanks to pharmacological treatment, the person does not feel symptoms or particular disturbances in daily activities and does not have bronchospasm, responsible for exacerbations. For this reason, attention to therapy and control of the disease are fundamental in all asthmatic people, to reduce the impact of the disease on quality of life and the doctor-patient alliance plays a fundamental role in this.
Those suffering from asthma should be more aware of their disease, of how to manage it, of undergoing periodic check-ups by the specialist, of the importance of adherence to therapy, the ability to perform the inhaler technique correctly and to eliminate modifiable risk factors such as smoking. Patients who are treated appropriately and regularly can lead a normal life, without limiting themselves in their daily attitudes and actions, from work to leisure time and sport. However, in a significant percentage of patients, asthma control remains unstable and this is largely due to an under-treatment of the pathology, says Claudio Micheletto, UOC Director of Pneumology, Integrated University Hospital of Verona. Among the major problems in the management of asthma is poor adherence to inhaled therapy: many patients tend to underestimate the disease and, in the non-acute phases, abandon basic therapy. The availability of a triple therapy which allows the use of a single inhaler and with two different dosages, represents an important simplification for the patient, to the benefit of therapeutic adherence.
Even the mildest forms may not be optimally controlled, and this is mainly due to the patient’s poor adherence to inhalation therapy. In Italy, it continues to be a highly critical element, with levels below 20 percent. An estimated 24 percent of exacerbations and 60 percent of asthma-related hospitalizations are attributable to poor adherence. Lack of asthma control can greatly affect people’s daily lives. Due to the persistence of symptoms and the fear of incurring an asthma attack, possibly severe, patients limit social relationships, are absent from work, give up practicing sports, thus triggering a vicious circle that compromises their quality of life and the state of health, explains Simona Barbaglia, President of the National Association of Patients Let’s Breathe Together. Education and dialogue with the patient are essential to gain awareness of their disease and allow them to manage and control it effectively, improving their adherence to therapy.
April 7, 2023 (change April 7, 2023 | 08:54)
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