title: Achieving asthma control in practice: understanding the reasons for poor control.
abstract: Achieving asthma control remains an elusive goal for the majority of patients worldwide. Ensuring a correct diagnosis of asthma is the first step in assessing poor symptom control; this requires returning to the basics of history taking and physical examination, in conjunction with lung function measurement when appropriate. A number of factors may contribute to sub-optimal asthma control. Concomitant rhinitis, a common co-pathology and contributor to poor control, can often be identified by asking a simple question. Smoking too has been identified as a cause of poor asthma control. Practical barriers such as poor inhaler technique must be addressed. An appreciation of patients' views and concerns about maintenance asthma therapy can help guide discussion to address perceptual barriers to taking maintenance therapy (doubts about personal necessity and concerns about potential adverse effects). Further study into, and a greater consideration of, factors and patient characteristics that could predict individual responses to asthma therapies are needed. Finally, more clinical trials that enrol patient populations reflecting the real world diversity of patients seen in clinical practice, including wide age ranges, presence of comorbidities, current smoking, and differing ethnic origins, will contribute to better individual patient management.
authors.affiliation: Department of General Practice and Primary Care, University of Aberdeen, Foresterhill Health Centre, Westburn Road, Aberdeen AB25 2AY, Scotland, UK. j.haughney@abdn.ac.uk
authors.forename: John
authors.initials: J
authors.lastname: Haughney
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.forename: Alan
authors.initials: A
authors.lastname: Kaplan
authors.forename: Henry
authors.initials: H
authors.lastname: Chrystyn
authors.forename: Rob
authors.initials: R
authors.lastname: Horne
authors.forename: Nick
authors.initials: N
authors.lastname: May
authors.forename: Mandy
authors.initials: M
authors.lastname: Moffat
authors.forename: Jennifer
authors.initials: J
authors.lastname: Versnel
authors.forename: Eamonn R
authors.initials: ER
authors.lastname: Shanahan
authors.forename: Elizabeth V
authors.initials: EV
authors.lastname: Hillyer
authors.forename: Alf
authors.initials: A
authors.lastname: Tunsäter
authors.forename: Leif
authors.initials: L
authors.lastname: Bjermer
mesh_terms: D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001249:Asthma / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy*; D002648:Child; D004351:Drug Resistance; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D009330:Nebulizers and Vaporizers; D010349:Patient Compliance; D010353:Patient Education as Topic / Q000379:methods; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012220:Rhinitis / Q000150:complications / Q000188:drug therapy; D012907:Smoking / Q000009:adverse effects
chemical_list: D018927:Anti-Asthmatic Agents; D005938:Glucocorticoids