Management of asthma in primary care

Honkoop, Pieter Jacob (2016)

Doctoral Thesis

Asthma is a common non-communicable respiratory disease. In this thesis we analysed three different management strategies for adult patients with asthma in primary care. In the first, we targeted the currently recommended aim of __Controlled asthma__, which means patients experience hardly any symptoms. The second targeted __Partly Controlled asthma__, which allowed some symptoms. The third additionally used a FeNO-measurement to assess current control. Aiming for Partly Controlled asthma significantly reduced medication usage compared to Controlled asthma, while exacerbation-rate, quality of life and asthma control were similar. FeNO-guided Controlled asthma also significantly reduced medication usage compared to Controlled asthma and additionally significantly improved asthma control compared to Partly Controlled asthma. Aiming for FeNO-guided Controlled asthma is therefore the optimal strategy. In this thesis we also analysed daily measurements of symptoms and peak-flow, which are recorded in Written Asthma Action Plans, or in apps. Hereby we were able to predict future asthma exacerbations several days in advance with reasonable accuracy. Finally, we compared an online assessment of asthma control by a questionnaire with the results of the same questionnaire assessed by a practice nurse. We showed that asthma control is perceived as better when interacting with a caregiver than by online self-assessment.

• FeNO
• Action-plan
• Action point
• Online
• Cost-effectiveness
• Control
• Exacerbation
• Asthma

• All authors: Honkoop, Pieter Jacob
• Supervisor: Kievit, J.; Assendelft, W.J.J.
• Co-supervisor: Sont, J.K.
• Qualification: Doctor (dr.)
• Awarding Institution: Department of Quality of Care and department of Public Health and Primary Care, Faculty of Medicine, Leiden University Medical Center (LUMC), Leiden University
• Date: 2016-01-14
• ISBN (print): 9789461697950
• Sponsorship: Zon-MW Longfonds