Introduction: how can we improve asthma management?

Asthma remains a poorly controlled disease both in Europe and the USA despite the availability of effective asthma treatments. Patient noncompliance, incorrect use of inhaler devices, insufficient treatment of peripheral airway inflammation as well as limitations of the asthma management guidelines themselves may all contribute to this poor control. Asthma control may be improved by improving the consultation process during the visit at the doctor. The ideal consultation would involve critical listening to the patient, accurate assessment of asthma symptoms as indicators for asthma control and prescribing the appropriate medication and dose for the individual patient according to the degree of severity of asthma. In addition, correctness of inhalation technique as performed by the patient should be regularly checked; patients should be educated and trained how to manage their personal condition and should be offered convenient follow-up options. Choosing the right inhaler for the patient may improve patient compliance. Inhaler choice should be based on an evidence-based rationale rather than on an empirical basis. The preference of the patient should also be taken into consideration, as it is the patient who has to use the inhaler daily over a long period of time. The ideal inhaler should demonstrate sufficient drug delivery to the lower airways as well as good drug distribution to both the central and peripheral airways. It should ensure consistency of the emitted dose, be easy to teach and use, be small in size and convenient to handle. It should also be multi-dose, require a low inspiratory airflow for activation, provide feedback to the patient on correct inhalation technique, be re-usable/refillable, have an appealing design, and have a reliable dose counter.