REVIEW  ASTHMA AND SEVERE ASTHMA MANAGEMENT IN THE CLINICAL PRACTICE 

Minerva Medica 2021 October;112(5):582-604

DOI: 10.23736/S0026-4806.21.07277-3

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Managing asthma in primary healthcare

Jaime CORREIA-DE-SOUSA ¹ ✉, Cláudia VICENTE ², Dinis BRITO ^{1, 3}, Ioanna TSILIGIANNI ^{4, 5}, Janwillem W. KOCKS ^{4, 6, 7, 8}, Miguel ROMÁN-RODRIGUEZ ⁹, Noel BAXTER ⁴, Tiago MARICOTO ^{10, 11}, Siân WILLIAMS ⁴

¹ ICVS/3B’s Associate Laboratory, Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ² Araceti Family Health Unit, Coimbra, Portugal; ³ .7 Fontes Family Health Unit, ACES Cávado I - ARS Norte, Braga, Portugal; ⁴ International Primary Care Respiratory Group, Edinburgh, UK; ⁵ Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Greece; ⁶ General Practitioners Research Institute, Groningen, the Netherlands; ⁷ GRIAC Research Institute, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands; ⁸ Observational and Pragmatic Research Institute, Singapore, Singapore; ⁹ Primary Care Respiratory Research Unit, Health Research Institute of the Balearic Islands (IdISBa), Palma, Spain; ¹⁰ Aveiro-Aradas Family Health Unit, Aveiro Health Center, Aveiro, Portugal; ¹¹ Faculty of Health Sciences, University of Beira Interior, Covilhã, Portugal

Asthma brings considerable challenges for family doctors because of its variety of shapes, different levels of severity, a wide age range, and the fact that in the last decades clinicians are able to offer much better treatment options with a better level of disease control and a higher quality of life. The objectives of the current review article are to provide an up-to-date review by primary care respiratory leaders from different countries of the most significant challenges regarding asthma diagnosis and management, the importance of team work and the problems in recognizing and dealing with difficult-to-manage and severe asthma in primary care. The article provides a short review of the main challenges faced by family physicians and other primary health care professionals in supporting their patients in the management of asthma, such as asthma diagnosis, promoting access to spirometry, the importance of a multiprofessional team for the management of asthma, how to organize an asthma review, the promotion of patient autonomy and shared decision-making, improving the use of inhalers, the importance of the personalized asthma action plan, dealing with difficult-to-manage and severe asthma in primary care and choosing when, where and how to refer patients with severe asthma. The article also discusses the development of an integrated approach to asthma care in the community and the promotion of Asthma Right Care.

KEY WORDS: Asthma; Primary health care; Patient care team; Disease management; Self care; Shared decision making