The Further Initiative

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Taking the patient voice FURTHER in their asthma journey

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Learn more about the FURTHER initiative’s multi-disciplinary insights on asthma, through the lens of the patient journey. We examine the different opportunities and challenges that adult patients with asthma face, while exploring the role that health systems, guidelines, and contextual factors like comorbidities and provider-patient relationships play in shaping these experiences.

Executive summary

Significant and impactful progress has been made in the treatment of asthma worldwide. The introduction of global guidelines, advances in medicine and better understanding of the disease has caused mortality rates to decline significantly in the past 30 years. Despite this progress, more can and should be done to improve asthma management across the world. As more people are diagnosed each year and people live longer with the condition, gaining control over asthma is imperative to ensuring that patients do not suffer from severe disability and can improve their quality of life. Well-managed asthma provides great economic benefit to both the individual and the health system. This is particularly relevant for individuals of low socioeconomic status and health systems with scarce resources.

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Major gaps still exist in the management of asthma. Consistent, preventive and proactive treatment is a cornerstone of asthma management. However, some guidelines and treatment approaches continue to rely heavily on reliever medications, which are less economically viable and less effective in treating the underlying causes of asthma in the long term. National guidelines should promote the most sustainable, effective and costeffective treatment options that are available (and accessible), and countries should prioritise the subsidisation and availability of these treatments for their citizens. Other preventive approaches are equally important, including the avoidance of smoke, pollution, allergens and obesity. Unfortunately, in many settings, particularly low- and middle-income countries, the avoidance of such risk factors in daily life is challenging. Regulatory and public health bodies can play a role in minimising the impact of these and biological environmental factors on individuals with asthma.

“To enable me to live with the best quality of life, it’s important for me to have the confidence to adapt my treatment, as needed, for activities I’m doing, for example exercise. Patients don’t often have the knowledge and therefore the confidence to do this. Having a chronic condition does come with sacrifice, and you need to understand why you cannot do all you wish, which can be very hard to come to terms with. With knowledge and the ability to balance your condition, you can live your life.”

Olivia Fulton, volunteer, Respiratory Voices Network, Asthma + Lung UK

Improvements to physician and patient education, and the creation of holistic, personalised treatment plans have the potential to resolve many challenges with asthma management. Educating physicians ensures better prescribing practices, assessment of patients and adherence to guidelines, while patient education can prevent misconceptions about asthma management, reduce negative perceptions or stigma and improve adherence to personal care plans. Collaboration and shared decisionmaking between patients and their physicians should be encouraged, as it facilitates mutual learning and understanding, while allowing the care pathway to be more patient-centred, tailored and sensitive. Asthma guideline development and implementation should also consider the experiences and perspectives of stakeholders in the wider asthma community, especially general practitioners and patients.

The future of asthma treatment and management is promising. Innovations in digital health and technology provide an opportunity to increase access and affordability of care, and enhance selfmonitoring, patient knowledge and continuity of care, with great potential to significantly improve patient outcomes across the world. Increased attention to the negative environmental impacts of traditional asthma inhalers is causing momentous changes in how inhalers are designed and used, which can significantly reduce the carbon footprint of asthma. However, advances in treatment are not impactful enough on their own. Innovation should stand alongside meaningful global, regional and national action to address and advance all aspects of asthma prevention, diagnosis, treatment, control and management.

Conclusion and key takeaways

This report has highlighted the many challenges and opportunities that exist in improving care and quality of life along an asthma patient’s journey. Gaps that exist in care are contextual, and dependent on a multitude of factors— health system structure and funding, patient and physician education and communication, adherence to guidelines and treatment plans, the accessibility and affordability of medication—all in the backdrop of larger issues such as the covid-19 pandemic and climate change.

With these in mind, asthma management could benefit from being more personalised and holistic. Leveraging opportunities to further improve care for people with or caring for those living with asthma does not require more standard pathways, but rather a deeper understanding of individual behaviours and health system barriers that prevent the best care being available to all.

We have identified five key takeaways that we believe will be important to further progress in asthma care:

The need for education of healthcare professionals around asthma care
Better education for physicians is required to enable asthma to be diagnosed as early as possible, as well as ensuring accurate prescription and treatment recommendations for patients living with asthma. Physician education should extend to recognising the physiological and psychological effects of mental health and stress on asthma and its management, and knowing how to enhance asthma management in patients with comorbidities and anxiety or panic disorders. Training in concepts around motivational communication can enablephysicians to better understand patient needs and reasons for poor adherence, and tailor information and advice accordingly. Recognising that GPs are often pressed for time when seeing patients, simple tools like ACT and peak flow meters can be administered during routine consultations to help patients better manage, monitor and control their asthma.

Strengthening two-way communication between providers and patients, together with shared decision-making
Shared decision-making is an essential component of asthma management. Communication, collaboration and sharing of information, values and preferences between the clinician and the patient builds consensus, understanding and action towards mutually beneficial treatments and results. This creates an opportunity to improve clinical outcomes, asthma control and quality of life for the patient, as it creates better patient understanding and satisfaction with care, which can lead to increased adherence to treatment. Shared decision-making also allows for the creation of programmes of care and education that are culturally specific and sensitive, which can significantly improve the outcomes of patients, specifically those in minority groups

Redefining patient empowerment, through efforts around health literacy and behavioural change
Patient empowerment is important to ensure that patient voices are valued and that treatment plans are adhered to. Many patients are not comfortable or do not have the confidence to communicate their concerns to doctors. A paradigm shift is needed to change the balance of power between patients and doctors so that patients are encouraged to ask questions about their treatment and engage with doctors in discussions and decisions about their care. A doctor’s advice should be a key source of information, but it should be supplemented with other resources and support, and the patient’s own knowledge from their lived experience.

The development of patient-friendly and country-level guidance on asthma
Patient-specific recommendations that support asthma education and management already exist, such as those developed by the Global Allergy and Airways Patient Platform and GINA (the latter of which has been translated into six languages). However, incorporating the diversity of patient experiences and developing personalised, specific information on self-management and empowerment is not an easy task. Building on the clinical practice guidelines for healthcare practitioners, further efforts are warranted to translate these guideline messages from scientific communication to social, non-technical, concise language—and, more importantly, develop tools that can better facilitate communication and knowledge sharing among individuals with asthma and their families. At a country level, culture and specific health system constraints need to be recognised in guideline implementation in order to provide quality, personalised care for all.

A renewed focus on holistic, personalised asthma care
Given the complexity of asthma as a condition, and the further complications that comorbidities could have on its management, it is essential that treatment decisions adopt a holistic, multidisciplinary, patient-centric approach to care. Personalised asthma action plans (PAAPs) can also empower patients to better manage their condition, with instructions from doctors to optimise outcomes. International and national guidelines recommend that individuals with asthma are offered and have access to self-management education including PAAPs, and studies have shown that the use of PAAPs may improve people’s confidence and skills in managing their health. Personalised care plans have been found to work best when health professionals are more closely involved in supporting their preparation, record-sharing, and care co-ordination and review.

“If we don’t work together, involving all stakeholders, we can’t have this holistic approach we need nowadays. It’s not only a conversation between the healthcare professional and the patient—we have to involve the families of patients, the larger health system, policymakers and politicians.”

Nicole Hass, patient access and stakeholder engagement, Spain

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The FUture of RespiraTory HEalth Readiness (FURTHER) Initiative is a global effort to address important questions on the future landscape of chronic respiratory disease. The FURTHER initiative is programmed by Economist Impact with the support of GSK. Economist Impact maintains editorial independence of the initiative.