Individualized Care Strategies

For individual patients, shared decision-making (SDM) about treatment should take into account any patient characteristics or phenotype that predict the patient’s risk of exacerbations or other adverse outcomes, or their likely response to treatment, together with the patient’s goals or concerns and practical issues (inhaler technique, adherence, medication access and cost to the patient).¹ A person’s willingness and ability to engage in self-management may vary depending on factors, such as ethnicity, literacy, understanding of health concepts, numeracy, beliefs about asthma and medications, desire for autonomy and the healthcare system. As an intervention, SDM for medication/dose choice improved adherence and patient outcomes.²

Written Asthma Action Plan

Having a written action plan can document and support SDM while providing practical guidance on the use of medications. Additionally, it can act as a reference for the patient so they can recognize and respond to symptoms and it should be reviewed regularly by the patient and their healthcare team.

In the management of asthma, shared decision-making is a crucial part of the treatment program. Patients must be able to make informed decisions about their treatment using the best available evidence. Patients should be aware of both the benefits and potential side effects associated with systemic therapies for asthma.¹

To enable shared decision-making, clinicians can use tools and resources, such as the shared decision-making tool developed by the AHRQ.⁴When patients with asthma are a part of the shared decision-making process, they may be more likely to adhere to asthma therapy and take charge of their goals for management of asthma.⁴ Explore other areas of the BREATHE Asthma portal for more asthma tools and resources for providers.

The Impact of Person-Centered Care

In the management of severe asthma, shared decision-making is a crucial part of the treatment program. Patients must be able to make informed decisions about their treatment using the best available evidence. Patients should be aware of both the benefits and potential side effects associated with systemic therapies for severe asthma.¹

To enable shared decision-making, clinicians can use tools and resources, such as the shared decision-making tool developed by the CHEST foundation. When patients with severe asthma are a part of the shared decision-making process, they may be more likely to adhere to asthma therapy and take charge of their goals for management of severe asthma. At The Breathe Initiative, we have severe persistent asthma tools and resources for providers.

SELECTION OF THERAPY IN SEVERE ASTHMA

In the selection of asthma therapy, it is crucial that clinicians take into account multiple biomarkers associated with severe asthma, including IgE testing, skin testing, total serum IgE levels, as well as eosinophil levels and nitric oxide concentrations in exhaled breath. When these biomarkers exceed certain levels, patients may qualify for certain treatments available for specific phenotypes of severe asthma, including asthma associated with aeroallergens and asthma associated with increased levels of eosinophils. Predictors of improved therapeutic response may include the presence of nasal polyps in patients receiving anti–IL-5 or anti–IL-5R therapy, the presence of atopic dermatitis in patients receiving anti–IL-4 therapies, or childhood-onset asthma in patients receiving anti-IgE therapy. Selection of treatment based on current guidelines and specific patient features may help optimize the likelihood of long-term response in cases of severe asthma.¹

The use of asthma therapy treatments may also be informed by the latest evidence, as evaluated in a recent systematic review that estimated reductions in exacerbation rates with specific treatment options. Reviewing these data can help in the discussion of treatment options with patients in a comprehensive resource based on the latest severe asthma management data.