Difficult-to-treat asthma: the most significant factors impeding control

Aim. The study of clinical and functional characteristics, features of pharmacotherapy and the level of adherence in severe and difficult-to-treat bronchial asthma in real clinical practice to optimize pathogenetic therapy measures.

Materials and methods. 143 patients diagnosed with severe bronchial asthma were examined. Patients were divided into 2 groups: difficult-to-treat bronchial asthma and severe bronchial asthma. Examination methods included: anamnestic method, physical examination, filling out the ACQ-5 questionnaire, AST, the Morisky-Green questionnaire, instrumental (spirography with bronchodilator), laboratory methods.

Results. Most of the studied patients were patients with difficultto-treat bronchial asthma (55%), while patients with severe bronchial asthma accounted for 45% of the total number of patients. We noted that patients of the 1st group were more often hospitalized due to an exacerbation of the disease. There were no significant differences in clinical and functional parameters and in the structure of comorbidity. All patients received the amount of basic therapy corresponding to stages 4 and 5 in accordance with GINA 2022. According to the results of the Morisky-Green questionnaire, lack of adherence was recorded in 79% of cases. Incorrect inhalation technique among patients of the 1st group was recorded in 32% of cases, while an uncontrolled course of concomitant pathology was detected in a third (33%) of cases. In group 2, 94% of patients had at least one marker of T2 inflammation.

Conclusions. Among patients with difficult-to-treat asthma, truly severe bronchial asthma was confirmed in 45% of cases, bronchial asthma difficult-to-treat - in 55% of cases. Lack of adherence (79% of cases), uncontrolled course of comorbidity (33%), and incorrect inhalation technique (32% of cases) are the main factors hindering the achievement of control in the difficult-to-treat asthma group. For patients with difficult-to-treat asthma, it is necessary to take measures aimed primarily at improving adherence to treatment.

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