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Prof. Giorgio Walter Canonica Allergy and Respiratory Diseases Department University of Genoa

Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra. Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale. Modena LIBRA, March 1st,2011. Unmet Needs in ASTHMA and COPD.

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Prof. Giorgio Walter Canonica Allergy and Respiratory Diseases Department University of Genoa

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  1. Grazie per aver scelto di utilizzare a scopo didattico questo materiale delle Guidelines 2011 libra.Le ricordiamo che questo materiale è di proprietà dell’autore e fornito come supporto didattico per uso personale.

  2. Modena LIBRA, March 1st,2011 Unmet Needs in ASTHMA and COPD Prof. Giorgio Walter Canonica Allergy and Respiratory Diseases Department University of Genoa Past President 1°vice President

  3. COPD

  4. Calverley, B.J.P. 2008

  5. Calverley, B.J.P. 2008

  6. Decramer et al. Resp.Med.2011

  7. Decramer et al. Resp.Med.2011

  8. Decramer et al. Resp.Med.2011

  9. CONCLUSIONS Decramer et al. Resp.Med.2011

  10. Morales Asenco et al. BMC 2010

  11. PROsPatient Reported Outcomes

  12. Real-life observational studies Patientreported outcomes Disease phenotype Therapy Diseasecontrol measures Aetiology Severity Comorbidities Drugs Schedule Symptoms Score Composite Score Function Biology Clinical parameters Resource utilisation Preference Awareness Satisfaction Behaviour Coping Adherence Stress Anxiety/depression Quality of life Alexithymia Mood

  13. Braido et al. CMRO 2011

  14. Braido et al. CMRO 2011

  15. Braido et al. CMRO 2011

  16. ASTHMA

  17. GUIDELINES

  18. Asthma guidelines

  19. Asthma Control inReal Life

  20. Worldwide epidemiological evaluation of asthma control level 2509 patients with asthma2 7 European countries 2803 patients with asthma1 AIRLA Asthma Insights and Reality in Latin America 8 Asian-Pacific countries 3206 patients with asthma3 11 Latin American countries 2184 patients with asthma 1. Rabe et al. Eur Respir J 2000; 16: 802-8072. www.asthmainamerica.com 3. Lai et al. Eur Respir J 2003; 111: 263-268

  21. Achieving control in asthmatic patients: still a critical issue? Braido et al. Allergy 2009; 64: 937-943 Total control Well controlled Uncontrolled 122 patients51.3% LABA + ICS16 PTZ high-dose L + I patients treated with high-dose ICS + LABA the total sample Levels of asthma control in the total sample (right), and in the subgroup of patients treated with high-dose ICS + LABA (left)

  22. Patients’ opinions on their asthma Asthma 96 patients Do you think your disease is under control? Do you think you relied on qualified professionals? How do you cope with your disease? Have drugs improved your disease? Are you following doctors’ prescriptions? Do you think your disease will improve? Do you feel helped by your family? Do you feel helped by all the medical staff? Not at all – – 3.1% – 1.0% 19.8% 8.3% – A little 12.5% 7.3% 16.7% 14.6% 5.2% 33.3% 7.3% 10.4% Fairly 58.3% 53.1% 51.0% 53.1% 50.0% 26.0% 36.5% 66.7% A lot 22.9% 32.3% 24.0% 26.0% 39.6% 9.4% 33.3% 21.9% Not indicated 6.3% 7.3% 5.2% 6.3% 4.2% 11.5% 14.6% 1.0% Baiardini et al. J Investig Allergol Clin Immunol 2006; 16: 218-223

  23. Real-life asthma management Braido et al. J Investig Allergol Clin Immunol 2010; 20: 9-12

  24. Why do doctors and patients not follow guidelines? Baiardini et al. Curr Opin Allergy Clin Immunol 2009; 9: 228-233

  25. Why do doctors not follow guidelines? • LACK of: • Consciousness • Familiarity • Agreement • Auto- effectiveness • Success expectation • Motivation and consolidation • External barriers Baiardini et al. Curr Opin Allergy Clin Immunol 2009; 9: 228-233

  26. Why do patients not follow guidelines? Baiardini et al. Curr Opin Allergy Clin Immunol 2009; 9: 228-233

  27. Adherence to treatmentis a weak pointin asthma management

  28. World Health Organisation2003 World Health Organisation

  29. Cutler and Everett. NEJM 2010; 362: 1553-1555

  30. Cutler and Everett. NEJM 2010; 362: 1553-1555

  31. Cutler and Everett. NEJM 2010; 362: 1553-1555

  32. COPD

  33. Breekveldt-Postma et al. Pharmacoepidemiol Drug Saf 2008; 17: 411-422 Overall persistence with single and fixed ICS treatment in new users with asthma Fixed Single Adults Children and adolescents 1.0 1.0 0.8 0.8 0.6 0.6 Proportion of persistent ICS users by formulation in adults Proportion of persistent ICS users by formulation in children and adolescents 0.4 0.4 0.2 0.2 0.0 0.0 0 50 100 150 200 250 300 350 400 0 50 100 150 200 250 300 350 400 Time since start of therapy (days) Time since start of therapy (days)

  34. Unmet needs in asthma: Global Asthma Physician and Patient (GAPP Survey): global adult findings Canonica et al. Allergy 2007; 62: 668-674

  35. Patients and physicians disagree on content of education provided and received Correct inhaler technique Develop individual management plan Patients perceive that only 25% of office visit time is devoted to asthma education Monitor peak expiratory flow Keep daily symptom/medication diaries Contact patient support organisation Respondents (%) Does your doctor or other healthcare professional in his or her office discuss any of the following with you? Base: all respondents (patients) Do you regularly discuss the following with your asthma patients? Base: all respondents (physicians) Canonica et al. Allergy 2007; 62: 668-674

  36. Treatment compliance increases with increased patient education Patient treatment compliance Amount of time spent on patient education <51% 15% 51-80% 27% 81-99% 29% 100% 30% Increase in compliance (%) Canonica et al. Allergy 2007; 62: 668-674

  37. Time with doctor in primary care Malaysia 5-10 mins Pakistan <3 mins UK 8 mins Australia 15 mins South Africa 8-11 mins Italy 8 mins E Bateman

  38. This should be avoided!!!

  39. Can asthma control be improved by understanding the patient’s perspective? Patient Horne et al. BMC Pulm Med 2007; 7: 8

  40. Asthma: physician’s and patient’s viewpoint – two different perspectives Asthma Inflammation Comorbidity IgE Atopy Histamine Bronchoconstriction FEV1 Asthma Sleep Eating Physical functioning Social life Sport Work Performance Mental functioning School Performance Physician Patient

  41. A general process in guidelines evolution Evidence-based medicine

  42. Factors that influence the strength of a recommendation • Balance between desirable and undesirable effects • Quality of evidence • Patients’ values and preferences • Costs

  43. PROs to support medical product labelling claims:FDA perspective PROs provide a unique perspective on medical therapy, because some effects of a health condition and its therapy are known only to patients Patrick et al. Value Health 2007; 10 (Suppl 2): S125-S137 FDA, Food and Drug Administration

  44. Braido et al. Allergy 2010: DOI: 10.1111/j.1398-9995.2010.02383.x.

  45. Baiardini et al. J.ASTHMA 2011

  46. Baiardini et al. J.ASTHMA 2011

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