title: Many asthma patients experience persistent symptoms despite appropriate clinical and guideline-based treatment with inhaled corticosteroids.
abstract: OBJECTIVE
  To review possible reasons for persistence of asthma symptoms despite appropriate use of clinical and guideline-based treatments, including the use of inhaled corticosteroids.
  
  
  METHODS
  Review of the worldwide scientific literature on factors related to persistent symptoms in patients with asthma.
  
  
  CONCLUSIONS
  Patients with asthma may not respond as expected to therapy because of factors that include poor adherence, improper inhaler technique, persistent exposure to symptom triggers, and limitations of current standard therapy, including steroid insensitivity or the steroid plateau effect. Persistent symptoms may also be associated with IgE-mediated airway inflammation, as current standard asthma therapies do not directly address the IgE-mediated component of the inflammatory cascade. Asthma is a complex disease and its treatment requires the full cooperation and participation of the patient.
  
  
  CONCLUSIONS
  Healthcare professionals can play a key role by educating patients and their family members about the nature of asthma and rationale for treatment, supporting the importance of strict adherence to prevention measures and the prescribed treatment regimen.
authors.affiliation: Nassau Chest Physicians, P.C., Massapequa, New York, USA. jmogil@nassauchest.com
authors.forename: Joan
authors.initials: J
authors.lastname: Mogil
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000627:therapeutic use*; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D001249:Asthma / Q000188:drug therapy* / Q000523:psychology; D002985:Clinical Protocols; D015897:Comorbidity; D004359:Drug Therapy, Combination; D019983:Guideline Adherence; D006801:Humans; D007073:Immunoglobulin E / Q000187:drug effects / Q000276:immunology; D020024:Leukotriene Antagonists / Q000627:therapeutic use; D009722:Nurse Practitioners; D024802:Nurse's Role; D000069444:Omalizumab; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000379:methods; D012307:Risk Factors; D012720:Severity of Illness Index; D017211:Treatment Failure; D016312:Treatment Refusal
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents; D000888:Antibodies, Anti-Idiotypic; D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D020024:Leukotriene Antagonists; D000069444:Omalizumab; D007073:Immunoglobulin E