Difficult To Treat Asthma - Managing Your Asthma: Adult Asthma

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Difficult-to-treat asthma

Although the majority of asthma patients can control their asthma with proper treatment, a small number of patients will continue to have symptoms even with the best therapy. Patients who do not reach an acceptable level of control at Step 4 have what is known as "difficult-to-treat asthma." These patients may not respond well to corticosteroids. They may have ongoing exposure to potent triggers of asthmatic inflammation or may have difficulty complying with their prescribed treatment program. Uncontrolled nasal and sinus disease or gastroesophageal reflux disease (GERD) may also be a cause of difficult-to-treat asthma.

Your doctor may wish to consider the following:

• Confirm the diagnosis of asthma, while also checking for COPD and vocal cord dysfunction (which have similar symptoms to asthma).

• Go over your treatment to make sure you are using your medicines exactly as prescribed. Incorrect or inadequate use of medications remains the most common reason for failure to achieve control.

• Talk about smoking. If you used to smoke, this may help explain your current difficult-to-treat asthma. If you currently smoke, quit — smoking can reduce the effectiveness of inhaled and oral corticosteroids and worsen bronchial inflammation.

• Investigate the presence of other medical conditions that may aggravate your asthma. Chronic sinusitis, GERD, and obesity with obstructive sleep apnea are more common in patients with difficult-to-treat asthma. Psychological and psychiatric disorders should also be considered. If your doctor finds you do have any of these other conditions, you should be treated for them, although it's no guarantee that this will bring your asthma under control.

If your doctor has addressed all these issues with you and your asthma still isn't under control, the goal will be to minimize flare-ups and need for emergency medical treatment, while achieving as high a level of control as possible with as little disruption of activities and as few daily symptoms as possible. You may still need to use rescue medication often.

If you have difficult-to-treat asthma and are not already under the care of an asthma specialist, ask your primary care doctor for a referral. The specialist can test you to see if you have allergic asthma; if so, you might benefit from anti-IgE treatment with omalizumab (Xolair). The specialist can also determine if you are aspirin-sensitive, a condition that can be treated with leukotriene modifiers and aspirin desensitization followed by aspirin maintenance therapy.

Last updated:	September 27, 2007