Asthma challenges for Patients

Asthma as a disease is not evenly spread across the U.S.

There are definitely hotspots as shown in this study:  https://www.aafa.org/asthma-capitals/

Geography doesn’t change the basic problem in the lungs.

How do I find out the biggest challenges in dealing with the lungs of patients with asthma?

I talk to them!  

Some formal surveys have been done to dig into the problems asthma patients face in managing their diesease.  This survey in particiular revealed some of the biggest problems:  https://www.aaaai.org/about-aaaai/newsroom/news-releases/asthma

Let’s dig in and see what they found.

The study was titled: 

NEW STUDY SHEDS LIGHT ON THE CHALLENGES AND BARRIERS OF SEVERE ASTHMA MANAGEMENT

Surveys were administered to asthma sufferers and the results were summarized.

The paper reported that asthma sufferers:

1. Struggle to understand how best to manage asthma on a day-to-day basis;
2. Often have feelings that the public does not appreciate how seriously asthma impairs their health;
3. As a group, have common concerns about medication safety, especially ICS; and,
4. Experience a range of emotional impacts due to having severe asthma, especially anxiety and reluctance to hospitalization.

When I set out to improve asthma outcomes with Asthmaniac, I reflected on 31 years of medical practice when developing priorities for how to proceed. 

I have appreciated for a long time that asthma is a complex chronic disease.  

In order for patients to succeed in controlling it, they must understand it and must act on that understanding in order to take action at the right time.  

I designed the blog on Asthmaniac to address these core topics, using text, podcasts and videos.  

For each topic area discovered in the study above, I will describe how I designed Asthmaniac.com to address them.  The major concerns were:

1. Day-to-day management of asthma.
2. Public perceptions of asthma
3. Concerns about medication, especially ICS safety
4. Emotion impacts on social and health status.

Point 1.  

It has been clear to doctors for decades that patients need tremendous support in managing daily asthma symptoms.  

Peak expiratory flow (PEF) and symptom surveys (ACT) are a few methods devised to put numeric tools in patients’ hands to track the biologic status of their airways.  

It is believed that such tools allow patients to take the corrective action, earlier when acute bronchospasm starts. 

These tools require specific education and in most primary practices, time constraints get in the way of delivering that education as often and as personalized as needed.  

Asthmaniac solution: 

1. Simplify Asthma Action Plan; 
2. Make Action Plan readily accessible on the smartphone; 
3. Enhance knowledge competence as described 

Point 2. 

Public perceptions of asthma.  

The challenges of a pandemic complicated public messaging about any particular disease.  

There are no scientific studies showing us how public  under appreciation of asthma affects employment, social stigmatisation, school adherence, physical activity adherence.  

In absence of data, we leverage intuition and forge ahead.  

Asthmaniac solution: 

1. Develop content for a page that can become indexed by internet search methods that underscores the impacts of asthma on patient life (see new page titled Social Impact of Asthma). 
2. Address these perceptions with each patient to at least reinforce that these impacts are real, challenging, and generally under-appreciated (add this question to our pre-post patient insights survey).

Point 3. 

Medication safety.  

Patient concerns about inhaled corticosteroids (ICS) seems to predominate.  

These concerns are not necessarily the same as those we physicians are thinking about.  

Nonetheless, ICS is essential in moderate and severe asthma control.  

To assure compliance with its use, we must address these concerns.  

Asthmaniac solution: 

1. Talk about the role of steroids generally and ICS specifically in asthma; 
2. Reinforce the goal of prescribing the lowest amount needed for each patient to avoid safety and side effect concerns; 
3. Consider the use of new pharmacologic agents in severe patients (like in e-asthma) that will allow reduction in oral and inhaled steroid use.

Point 4.  

We know from large samples of patients with chronic disease that the presence of one disease is highly associated with a second one.  

Considering the anxiety asthma sufferers share about losing control of their asthma, it is not surprising that they would be at higher risk for other chronic diseases linked to anxiety.  

So, WE MUST GET THIS ANXIETY UNDER CONTROL.  

In absence of any controlled studies, I believe areas to attack in gaining control of asthma anxiety are:

1. Controlling asthma:  Asthma attacks are very frightening.  Preventing them will go a long way in allowing patients to settle emotionally.
2. Dramatically increased patient understanding of their disease and how to manage it daily will also be settling.  Knowledge deficits are specifically identified by patients as a major problem (see point 1).

Asthmaniac solution: We are all highly digital in our lives and your phones are never far from reach.  Leveraging the phone as a tool to correct these issues is a solution that has not been optimized (yet!):  With Asthmaniac.com, I aim to:

1. make sure patients can access (through affordable, phone based care) rescue inhalers, oral steroids, controller medication and trigger medication (the core functionality of Asthmaniac.com) 
2. Continually improve knowledge competence for self-management through phone/computer based contemporary media that is easily and affordably consumed (podcasts, video-casts, and online webinars that are announced to patients with email and text notifications). 
3. Assess anxiety in each patient and develop a personalised response plan for each patient.  This will have to be a new component in the pre-post patient insights survey.

I believe specifically and clearly addressing the concerns highlighted in the group of asthma sufferers surveyed in this study will lead to better outcomes for all asthma sufferers who can access the Asthmaniac.com method. 

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And keep Breathing Easy!

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