Barriers to Treatment

In the management of asthma, healthcare professionals are challenged with barriers that hinder the integration of evidence-based recommendations into clinical practice (figure). Additionally, patients should be assessed for potential barriers to treatment, including the economic, physical, mental, emotional, and social burden imposed by this condition (figure). Considerations of medication-related adverse events, which may be a barrier to continued treatment, should also be assessed, as well as potential comorbidities, drug interaction, and inhaler technique.¹

Additional patient specific challenges that may affect asthma care are:

Physical barriers, eg, arthritis, that limit use of an inhaler
Availability and affordability of inhaled medications
Adolescents should be seen separately from their parent/caregiver to discuss sensitive issues, such as smoking, adherence, and mental health privately
Adolescents may be concerned about the effects of treatment on their physical or sexual capabilities
Barriers to medication use including cost, concerns about necessity or side-effects

Strategies for overcoming barriers

To address these barriers specific steps need to be followed to incorporate clinical practice recommendations into local patient care. Ideally, interventions should be applied at both the patient and healthcare provider levels, and where applicable, the healthcare system.

High-Impact Interventions in Asthma Management

Additional interventions to improve asthma care regardless of clinical environment can include the following:

Early use of inhaled corticosteroid (ICS) treatment
Free ICS for those with severe asthma and/or after a recent hospital admission
Reduced exposure to tobacco smoke
Patient education and guided self-management
Checklist memory aid and written individualized asthma action plans
Clinical review of memory aid to assist asthma control and treatment strategy evaluation

Reference

Global Initiative for Asthma (GINA). Global Strategy for Asthma Management and Prevention (2023 update). Updated July, 2023. https://ginasthma.org/severeasthma/. Accessed January 22, 2023.