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Vol 6, No 3 (2007)
Original articles
Published online: 2007-11-07
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Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

Małgorzata Krajnik, Krzysztof Kuziemski, Iwona Damps-Konstanska, Beata Wajda, Lucyna Gorska, Karol Kempinski, Krzysztof Specjalski, Ewa Jassem
Advances in Palliative Medicine 2007;6(3):103-106.

open access

Vol 6, No 3 (2007)
Original articles
Published online: 2007-11-07

Abstract

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 FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 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.

Abstract

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 FEV1 was 55% (range: 34-104%) while 18 patients had FEV1 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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Keywords

asthma; cough; palliative medicine

About this article
Title

Difficult-to-treat asthma - an uncontrolled disease. Is there any relation to the experience from palliative medicine?

Journal

Advances in Palliative Medicine

Issue

Vol 6, No 3 (2007)

Pages

103-106

Published online

2007-11-07

Bibliographic record

Advances in Palliative Medicine 2007;6(3):103-106.

Keywords

asthma
cough
palliative medicine

Authors

Małgorzata Krajnik
Krzysztof Kuziemski
Iwona Damps-Konstanska
Beata Wajda
Lucyna Gorska
Karol Kempinski
Krzysztof Specjalski
Ewa Jassem

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