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Approaches to the assessment of severe asthma: barriers and strategies

Authors Majellano EC, Clark VL, Winter NA, Gibson PG, McDonald VM

Received 4 June 2019

Accepted for publication 25 July 2019

Published 23 August 2019 Volume 2019:12 Pages 235—251


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 4

Editor who approved publication: Dr Amrita Dosanjh

Eleanor C Majellano,1,2 Vanessa L Clark,1,2 Natasha A Winter,1,3 Peter G Gibson,1,4 Vanessa M McDonald1,2,4

1Faculty of Health and Medicine, National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, NSW, Australia; 2Faculty of Health and Medicine, School of Nursing and Midwifery, The University of Newcastle, Newcastle, NSW, Australia; 3Faculty of Health and Medicine, School of Medicine and Public Health, The University of Newcastle, Newcastle, NSW, Australia; 4Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, NSW, Australia

Correspondence: Vanessa M McDonald
Level 2 West Wing, Hunter Medical Research Institute, Locked Bag 1000, New Lambton Heights, NSW 2305, Australia
Tel +61 24 042 0146
Fax +61 4 042 0046

Abstract: Asthma is a chronic condition with great variability. It is characterized by intermittent episodes of wheeze, cough, chest tightness, dyspnea and backed by variable airflow limitation, airway inflammation and airway hyper-responsiveness. Asthma severity varies uniquely between individuals and may change over time. Stratification of asthma severity is an integral part of asthma management linking appropriate treatment to establish asthma control. Precision assessment of severe asthma is crucial for monitoring the health of people with this disease. The literature suggests multiple factors that impede the assessment of severe asthma, these can be grouped into health care professional, patient and organizational related barriers. These barriers do not exist in isolation but interact and influence one another. Recognition of these barriers is necessary to promote precision in the assessment and management of severe asthma in the era of targeted therapy. In this review, we discuss the current knowledge of the barriers that impede assessment in severe asthma and recommend potential strategies for overcoming these barriers. We highlight the relevance of multidimensional assessment as an ideal approach to the assessment and management of severe asthma.

Keywords: asthma, severe asthma, severity, assessment, barriers, strategies

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