Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome

Varkonyi-Sepp, Judit; Freeman, Anna; Ainsworth, Ben; Kadalayil, Latha Perunthadambil; Haitchi, Hans Michael; Kurukulaaratchy, Ramesh J.

doi:10.3390/jpm12091435

Open AccessReview

Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome

by

Judit Varkonyi-Sepp

^1,2,3

,

Anna Freeman

^1,2,4,

Ben Ainsworth

^2,5

,

Latha Perunthadambil Kadalayil

^1,2,

Hans Michael Haitchi

^1,2,4,6 and

Ramesh J. Kurukulaaratchy

^1,2,4,7,*

¹

School of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton SO16 6YD, UK

²

National Institute for Health Research (NIHR) Southampton Biomedical Research Centre, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK

³

Clinical Health Psychology Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK

⁴

Respiratory Medicine Department, University Hospital Southampton NHS Foundation Trust, Southampton SO16 6YD, UK

⁵

Department of Psychology, University of Bath, Bath BA2 7AY, UK

⁶

Institute for Life Sciences, University of Southampton, Southampton SO16 6YD, UK

⁷

The David Hide Asthma & Allergy Research Centre, St Mary’s Hospital, Isle of Wight, Newport PO30 5TG, UK

^*

Author to whom correspondence should be addressed.

J. Pers. Med. 2022, 12(9), 1435; https://doi.org/10.3390/jpm12091435

Submission received: 27 July 2022 / Revised: 26 August 2022 / Accepted: 29 August 2022 / Published: 31 August 2022

(This article belongs to the Special Issue Personalized Understanding and Management of Asthma and Allergy)

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Abstract

Three to ten percent of people living with asthma have difficult-to-treat asthma that remains poorly controlled despite maximum levels of guideline-based pharmacotherapy. This may result from a combination of multiple adverse health issues including aggravating comorbidities, inadequate treatment, suboptimal inhaler technique and/or poor adherence that may individually or collectively contribute to poor asthma control. Many of these are potentially “treatable traits” that can be pulmonary, extrapulmonary, behavioural or environmental factors. Whilst evidence-based guidelines lead clinicians in pharmacological treatment of pulmonary and many extrapulmonary traits, multiple comorbidities increase the burden of polypharmacy for the patient with asthma. Many of the treatable traits can be addressed with non-pharmacological approaches. In the current healthcare model, these are delivered by separate and often disjointed specialist services. This leaves the patients feeling lost in a fragmented healthcare system where clinical outcomes remain suboptimal even with the best current practice applied in each discipline. Our review aims to address this challenge calling for a paradigm change to conceptualise difficult-to-treat asthma as a multimorbid condition of a “Difficult Breathing Syndrome” that consequently needs a holistic personalised care attitude by combining pharmacotherapy with the non-pharmacological approaches. Therefore, we propose a roadmap for an evidence-based multi-disciplinary stepped care model to deliver this.

Keywords: asthma; co-morbidity; multimorbidity; personalized; non-pharmacological; therapy; treatment; treatable traits; difficult breathing syndrome; holistic treatment

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MDPI and ACS Style

Varkonyi-Sepp, J.; Freeman, A.; Ainsworth, B.; Kadalayil, L.P.; Haitchi, H.M.; Kurukulaaratchy, R.J. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. J. Pers. Med. 2022, 12, 1435. https://doi.org/10.3390/jpm12091435

AMA Style

Varkonyi-Sepp J, Freeman A, Ainsworth B, Kadalayil LP, Haitchi HM, Kurukulaaratchy RJ. Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. Journal of Personalized Medicine. 2022; 12(9):1435. https://doi.org/10.3390/jpm12091435

Chicago/Turabian Style

Varkonyi-Sepp, Judit, Anna Freeman, Ben Ainsworth, Latha Perunthadambil Kadalayil, Hans Michael Haitchi, and Ramesh J. Kurukulaaratchy. 2022. "Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome" Journal of Personalized Medicine 12, no. 9: 1435. https://doi.org/10.3390/jpm12091435

APA Style

Varkonyi-Sepp, J., Freeman, A., Ainsworth, B., Kadalayil, L. P., Haitchi, H. M., & Kurukulaaratchy, R. J. (2022). Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome. Journal of Personalized Medicine, 12(9), 1435. https://doi.org/10.3390/jpm12091435

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Multimorbidity in Difficult Asthma: The Need for Personalised and Non-Pharmacological Approaches to Address a Difficult Breathing Syndrome

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