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

3. 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

4. Asthma control, 2007 The Netherlands

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

6. Asthma management in the Netherlands

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

8. 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

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

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

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

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

13. What was in it for the patient?

14. Asthma processes

15. Asthma outcome

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

17. “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?

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

20. Asthma Medication 2015

21. 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%)

22. 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

23. 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!)

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

25. How low can you get.. ?

26. 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?