Asthma remains a significant public health concern in the US, affecting nearly 25 million individuals, including over 4.6 million children, and contributing to approximately 1 million emergency department visits annually, according to the CDC.

Asthma Surveillance in the United States, 2020-2021. CDC.

Severe asthma, impacting about 5%–10% of asthma patients, is characterized by poor symptom control and frequent exacerbations despite high-dose inhaled corticosteroids (ICS) and long-acting beta-agonists (LABA),

Kuruvilla ME, Lee FE, Lee GB. Understanding asthma phenotypes, endotypes, and mechanisms of disease. Clin Rev Allergy Immunol. 2019;56(2):219–233.

Global Strategy for Asthma Management and Prevention. GINA. 2023.

necessitating a more tailored and multidisciplinary approach to management. 

 

 

Get personal with your patients

 

John Lowe, MD, a board-certified physician specializing in asthma management at Restore Care in Ogden, UT, emphasizes the importance of individualized treatment plans.

Each patient’s asthma is different.

“A comprehensive assessment starts with spirometry to determine the severity and specific triggers," Dr. Lowe explains. "The extent of airway inflammation can be measured using objective methods such as fractional exhaled nitric oxide (FeNO) testing, allowing me to adjust therapy accordingly.”

Verónica Pardo Manrique, MD, an allergist working in a private practice in the city of Cali, Colombia, advises, “Identifying specific endotypes can guide the choice of biological therapies and other personalized interventions.”

If not previously performed, it is crucial to phenotype the patient to tailor treatment according to their clinical and biological profile.

However, personalization extends beyond the initial assessment. Joyce Yu, MD, a pediatric allergist and immunologist at Columbia University, Irving Medical Center, stresses, “Try to make the regimen as simple as possible.”

 

Use as few medications as possible so it is less confusing for the patient.

 

Implementing biologic therapies

 

"Biologics like omalizumab, mepolizumab, or dupilumab can significantly reduce the number of exacerbations when integrated into a broader asthma management strategy," explains Dr. Lowe. Their use should be based on the patient’s phenotype and endotype, which respond differently to different treatments.

The Global Initiative for Asthma (GINA) recommends biologicals as an add-on therapy for patients with uncontrolled severe asthma.

Global Strategy for Asthma Management and Prevention. GINA. 2023.

 

Biologics have helped to reduce the need for steroids [and provide] improved asthma control that we likely would not have achieved pre-biologics.

These therapies offer a promising option for patients with refractory asthma, with potential uses both for chronic management and as a rescue intervention until other underlying triggers such as obesity, allergens, and reflux disease are better taken care of. 

Dr. Manrique notes that integrating biologics requires “close monitoring of patients to evaluate treatment effectiveness and adjustment based on the patient’s response.” 

 

Takeaways for the clinic

 

A 2023 meta analysis highlights that one of the most significant barriers to treatment adherence is the lack of knowledge about the disease and the prescribed medication, often due to insufficient information from HCPs.

Zhang X, Ding R, Zhang Z, et al. Medication adherence in people with asthma: a qualitative systematic review of patient and health professional perspectives. J Asthma Allergy. 2023;16:515–527.

 

Dr. Lowe emphasizes the importance of patient education: "For patients to control their asthma, they need some knowledge.”

I provide all-inclusive teaching about inhaler techniques, trigger avoidance, and exacerbation action plans.

Consistent re-education is also vital, as Dr. Yu points out: "Every follow-up or check-up, I am constantly doing education and reeducation on what asthma is, the mechanisms, and the reasons behind the medications used." 

“Ensuring patients are using their inhalers correctly is key,” she adds. “Poor medication delivery often explains why a patient is not improving and prevents unnecessary increases in medication that might otherwise be wasted.” 

 

A written asthma action plan is recommended for all patients to improve adherence and outcomes. These plans help patients identify their triggers, recognize severe symptoms that require urgent attention, and distinguish between preventive and rescue therapies. 

Dr. Yu notes the value of educating patients about the dynamic nature of asthma management. "Seasonal plans, plans for the school year, and adjustments depending on the time of year can get confusing," she says. She advocates for clear communication about asthma as a chronic condition that requires "step up, step down" therapy, adjusting treatment based on symptom control rather than a static approach.

 

 

Try something new

 

Environmental and lifestyle modifications may also be necessary in a patient's treatment plan. "Identifying and preventing environmental triggers like allergies and pollutants are essential," Dr. Lowe emphasizes.

He advocates for promoting a healthy lifestyle: Addressing modifiable comorbidities, such as obesity, obstructive sleep apnea, stress, gastric reflux disease, and cardiovascular diseases, he says, is also crucial in improving outcomes.

The CDC recommends that all individuals with asthma, including children and adults, receive an annual flu vaccine, as they are at higher risk for severe complications and asthma exacerbations from influenza.

Flu vaccine among adults with current asthma. CDC. January 18, 2018.

 

 

Everything else you need to know

 

Using modern digital health tools like asthma apps and smart inhalers enhances patient adherence to medication, allows real-time monitoring of symptoms, and enables proactive management and early intervention during exacerbations.

The experts also stress the importance of a multidisciplinary approach in asthma management. According to Dr. Lowe, collaboration with pulmonologists, allergists, respiratory therapists, and pharmacists is key to developing a comprehensive care plan that addresses all aspects of the condition.