màj : 21/07/98 |
Difficult
asthma : a challenge for better understanding asthma Difficult asthma has not been defined by various national and international guidelines. However it exists and, for many clinicians it represents a daily challenge because the management of these patients requires specific expertises. Moreover from an economical point of view, these patients account for 80% of the total asthma-induced economic burden. At a first glance, difficult asthma could be defined as an uncontrolled asthma despite optimal management. Two types of difficult asthma could be considered: i) difficult asthmatics, who did not adhere to the manangement plan despite all the educational efforts, ii) true difficult asthma which is clearly linked to the absence of knowledge at present. The diagnosis of difficult asthma requires a long term follow-up (6 months to one year) and is compulsory to take into account all the aspects of the patients. The other diagnoses or associated conditions need to be clearly investigated. Fiberoptic bronchoscopy with bronchial biopsies is often required. Compliance would be measured precisely. Precipitating factors have to be investigated, recognised and treated. An international brain storming is ongoing in order to propose clear understanding difficult asthma. Several methods are used. The European Respiratory Society funds a task force on this subject and a document will be published soon; The European Communities ENFUMOSA, that is to say European Network For Understanding Mechanisms Of Severe Asthma. Study is on its way in 20 centers within Europe to control 200 severe patients. In several countries,, various initiatives and networks have been organized to improve the daily management of those patients. Asmanet contributes to this effort by publishing the minutes of a congress which has been organized in Montpellier (France) on the behalf of ENFUMOSA. The abstracts are available and should help to a better understanding of asthma in general. ( http://www.asmanet.com/enfumosa/ ) |
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