Setting Realistic Asthma Treatment Goals Across Diverse Patient Populations

"Setting Realistic Asthma Treatment Goals Across Diverse Patient Populations" features a candid exchange about how practice setting shapes what clinicians can realistically aim for.

Dr. Chupp opens the discussion by asking whether expectations for outcomes are shifting. In his group, physicians increasingly aim for the level of control Dr. Wechsler described as remission. With multiple biologics available, his team will consider switching patients who show only a partial response. The goal is to optimize symptom control or eliminate exacerbations entirely in those partial responders.

Dr. Mosnaim responds that her own main concern is avoiding exacerbations. She wants to prevent hospitalizations, emergency department visits, and oral steroid use before anything else. She grounds this view in her experience across very different practice settings.

She spent 18 years at Cook County Hospital and Rush University Medical Center before moving to Endeavor Health and the University of Chicago. At Cook County, about 25% of patients she saw in the emergency department returned within 3 weeks. Oral steroid use and exacerbation rates were tremendous.

In her current setting, she sees fewer hospitalizations and emergency visits. Oral steroid use, however, remains common and concerning. She walks through the arithmetic. A burst of 40 mg daily for 5 days totals 200 mg. Three bursts over a lifetime reach 600 mg, which exceeds the 500 mg threshold associated with added risk.

Five bursts push patients past the threshold linked to osteoporosis, cardiovascular disease, and other comorbidities. She worries about the long-term health consequences for her patients. For that reason, she takes what she calls baby steps. She addresses exacerbations first, before turning to clinical remission or other goals.

Dr. Chupp agrees this highlights an important point. His Connecticut population differs from hers, and disease morbidity varies from one location to another. He concludes that clinicians manage asthma according to the population in front of them.

The panel moves next to "Optimizing Asthma Adherence: Inhaler Technique, Cost, and Team-Based Care," where Dr. Chupp, Dr. Wechsler, and Dr. Mosnaim share practical strategies for the day-to-day barriers that undermine treatment.