Problem Cases in Asthma and Problems in Asthma Management

¹ The Division of Allergy-Immunology, Department of Medicine, Northwestern University Medical School, Chicago.

Asthma is theoretically manageable in all cases regardless of severity with modern pharmacologic and immunologic therapy. In the practical management of patients, however, not all cases of asthma can be managed easily or successfully. The failure to successfully manage asthma is the result of 2 broad categories. These include problem cases of asthma and problem patients with asthma. Problem cases of asthma are those patients in whom associated pulmonary disease such as irreversible COPD or stage 5 (end stage fibrotic lung disease) ABPA makes the management of asthma difficult or impossible because structural changes in the lung are the primary problem. Another group of problem cases of asthma is the result of coincidental disease such as severe organic heart disease or severe depression where adequate control of asthma becomes technically difficult or impossible.

Problem patients with asthma may be viewed separately from problem cases. In these patients, the asthma is clearly manageable but 1 or more of 3 aspects makes management difficult. These include a variety of psychologic problems in individual patients or socioeconomic factors interfering with adequate care. Finally, inadequate physician education or experience may result in a problem patient with asthma that would be manageable by an appropriate approach.