[Management of difficult-to-treat asthma using a flow sheet for systematic evaluation and therapeutic intervention].
BACKGROUND
Although most patients of asthma can be controlled by inhaled corticosteroid (ICS), some patients remain uncontrolled even after the introduction of ICS treatment. In management of such difficult-to-treat asthma, systematic review including additional differential diagnosis and avoidance of exacerbating factors is very important.


METHODS
Here we postulate a flow sheet presenting an algorithm which intends to achieve better asthma control following ATS refractory asthma guidance. For patients with poor controlled asthma even after using ICS more than moderate dose, we used the sheet in our daily outpatient management and investigated whether we could improve the control in such patients. The sheet was constructed by an algorithm which included (1) reevaluation of inhalation technique of ICS; (2) additional differential diagnosis of COPD and other similar diseases; and (3) reevaluation of presence of exacerbating factors.


RESULTS
In our outpatient department, seven clinicians managed 22 difficult-to-treat asthma patients using this sheet. Additional factors which might worsen asthma control could be detected in 21 patients (95.5%). Firstly, smoking was disclosed in 8 patients (36.4%). Secondly, keeping pets was identified in 7 patients (31.8%). 5 patients (22.7%) were diagnosed as COPD rather than asthma and 4 patients (18.2%) were diagnosed as having rhinosinusitis. Some improvement of asthma control was achieved in 9 patients (40.9%).


CONCLUSIONS
Reevaluation of refractory asthma patients using our newly developed flow sheet is essential and it may facilitate understanding of management of difficult-to-treat asthma.
Wakayama
Hisashi
H
Department of Respiratory Medicine, Nagoya Daini Red Cross Hospital. hwaka@nagoya2.jrc.or.jp
Ogasawara
Tomohiko
T
Sato
Ai
A
Honda
Mamiko
M
Sakurai
Keiko
K
Uemura
Takehiro
T
Kasai
Daishi
D
Kato
Hisaaki
H
Tomita
Yuka
Y
Park
Jangchul
J
Mizuno
Akiko
A
Suzuki
Masayuki
M
D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage; D000368:Aged; D000465:Algorithms; D000818:Animals; D000829:Animals, Domestic; D001249:Asthma / Q000175:diagnosis / Q000209:etiology / Q000628:therapy*; D002908:Chronic Disease; D003937:Diagnosis, Differential; D019468:Disease Management; D004282:Documentation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012907:Smoking / Q000009:adverse effects
D000305:Adrenal Cortex Hormones