Difficult-to-treat asthma — an uncontrolled disease. Is there any relation to the experience from palliative medicine?
2007
Background and aim. Difficult-to-treat asthma is characterized by uncontrolled symptoms occurring in
spite of intensive treatment (corticosteroids and long-acting β2-agonists) for at least 6 months and is
connected with severe obturation in the bronchotracheal tree. It still creates an important global medical
and economical problem. The aim of the study was to evaluate the occurrence of persistent symptoms,
exacerbating factors and co-morbidities in patients with difficult-to-treat asthma. It was also a challenging
idea to apply palliative medicine to help patients with this type of asthma.
Material and methods. Twenty-seven patients (21 women and 6 men, ages ranging from 23 to 60)
diagnosed with difficult-to-treat asthma were included in the study. Data were collected from the internet
database of severe, difficult-to-treat asthma, introduced to the Department of Allergology in 2005. All
patients’ spirometries and additional factors were assessed.
Results. The median predicted value of FEV 1 was 55% (range: 34-104%) while 18 patients had FEV 1 lower
than the 60% predicted value. All patients suffered from dyspnoea, chronic cough and wheezing and had
additional factors escalating the symptoms of asthma. The most important factor which leads to exacerbation
was long-term stress and rhinitis. Twelve (45%) patients from this group have poor tolerance of
exercise. In spite of intensive treatment, 17 (65%) patients constantly overused short-acting beta-agonists
(SABA) and all had long-term treatment with oral steroids. In most cases, co-morbidities were recognized:
obesity and hypertension.
Conclusions. This study showed that the role of additional factors and co-morbidities plays a significant
part in the course of asthma. It seems to be necessary to introduce a unified system of registering and
managing patients with severe and difficult-to-treat asthma. That palliative care is very important for
selected patients with chronic uncontrolled cough or dyspnoea should be a subject for newly planned
clinical trials.
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