Improving outcomes among adults with asthma

Abstract

Poor control is common among adults with asthma. Approximately 97% of deaths from asthma occur among adults. Improved care could avoid 75% of hospital admissions for asthma and up to 90% of deaths. A number of factors potentially contribute to poor outcomes among adults with asthma. Age itself seems to increase the chance of poor asthma control by 1% per year. This article examines modifiable factors associated with poor control in adults with asthma. For example, one third of adults with asthma admitted poor adherence. Depression and poor cognition undermine compliance and self-management, while psychological and respiratory symptoms interact to worsen control. Psychiatric comorbidity is relatively common among people with asthma; moreover, some maladaptive responses to stress potentially exacerbate asthma. Therefore, nurses should review patients' coping strategies and maintain a high index of suspicion for psychiatric conditions. Furthermore, nurses need to ensure that patients are on the appropriate step of the guidelines and consider reviewing the differential diagnosis if asthma remains poorly controlled. Increasing rhinitis severity and a greater number of cigarettes smoked each day were both associated with deteriorating asthma control. Therefore, nurses should optimize rhinitis management and encourage smoking cessation.