Treating Mild Asthma: what’s in it for the patient? Regien Kievits,

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Presentation transcript:

Treating Mild Asthma: what’s in it for the patient? Regien Kievits, Chair of CAHAG General Practitioner, Vught The Netherlands

Disclosure of Interest I declare that I do not have any affiliation with, or financial interest in a commercial organisation posing a conflict of interest with my presentation

Asthma control, 2007 The Netherlands

REALISE study Price, Fletcher, vd Moolen, Prim Care Resp J 2014 8000 asthma patients in 11 European countries

Asthma management in the Netherlands

How to achieve controlled asthma? Guidelines: - Asthma Guideline NHG (2007, 2015) - Multidisciplinary Guideline LAN (2012) Integrated care Focus on primary care

Integrated Care Asthma GP, practice nurse: protocolled care according to guidelines Lung specialist: consultation, referral guidelines Pharmacist: inhalation techniue, over/under prescription Pulmonary nurse Stop smoking support Fysiotherapist Dietist

Asthma Integrated Care The Netherlands 2015 18 Care Groups 2 Care Groups Integrated Care Asthma in Children

Caregroup southern part of the Netherlands 17 primary care practices (58 GP’s) Total population: 108.500 patients (2015) Asthma protocolled integrated care Started in 2008

Inclusioncriteria > 16 years Diagnosis Asthma And at least one of the following criteria: Mild – moderate Asthma (ICS indicated) Actual smoking

Asthma 2015 Prevalence: 4636 (4,3%) patients GP, no integrated care: 39,7 % (intermittent) Secundary care: 17,9 % GP, integrated care: 42,3 %

What was in it for the patient?

Asthma processes 2010-2015

Asthma outcome 2010-2015

Based on Asthma Clinical Questionnaire * 42% of Asthma patients receiving integrated care

“Treating mild asthma: what’s in it for the patient “Treating mild asthma: what’s in it for the patient?” Did these patients suffer from mild asthma?

GINA- / NHG- guidelines Asthma severity is a retrospective label, assessed from the lowest level of treatment needed to control asthma

Asthma Medication 2015

How could we reach 71% controlled asthma? Is it because of the right level of medication? Do we have so many patients with moderate asthma? (moderate 56% vs. mild 35%)

GINA-defined current asthma control levels for the 7 days before the survey Realise Study, Price D et al, 2014 Uncontrolled Partially controlled Controlled GINA-defined control was poor across all treatment levels, despite perceptions of control Asthma control was lowest among respondents prescribed a combination inhaler + oral pill Reliever inhaler only (n = 1419) Single-drug preventer inhaler (n = 1923) Combination preventer inhaler (n = 754) Combination preventer inhaler + pill (n = 234) Data shown for respondents on an identifiable treatment (n = 4330) GINA, Global Initiative for Asthma

Poor relationship between level of control and level of medication High relationship between level of control and integrated care (including: control inhalation, compliance, stop smoking!)

GINA- / NHG- guidelines Asthma severity is a retrospective label, assessed from the lowest level of treatment needed to control asthma

How low can you get.. ?

What’s in it for the patient? Achieving controlled (and partially) asthma Good inhalation technique Less smoking More Individual Care Plans Awareness of prescribed medication  how low you can get?