Asthma control: Patient and environment

Control of asthma, the goal of asthma treatment, seems hard to obtain. However, it is largely unknown why control of asthma remains difficult in many patients in spite of available powerful medication.
In this thesis we studied non-pharmacological factors influencing asthma control: patient related factors, such as adherence and health status, as well as environmental related factors such as exposure to house dust mite allergen. Finally we studied the effect of a combination of these patient and environment related factors as offered in high altitude treatment. This treatment combines patient centred treatment with a trigger free environment.
When asthma is poorly controlled the search for patient and environmental related factors is important. Focussed intervention, based on these specific factors offers opportunities to achieve asthma control in patients with uncontrolled asthma.
Conclusions:
1. Non-adherence is a frequent patient related factor in patients with controlled and uncontrolled asthma.
2. Measurement of clinical, physiological, functional and psychosocial domains of health status by the Nijmegen Clinical Screening Instrument (NCSI) provides a comprehensive, useful picture of the patient characteristics. The NCSI identifies factors and patterns that may influence control of asthma.
3. Mono intervention with anti- allergic mattress covers does not improve asthma control, however stabilizes the airway inflammation.
4. High altitude treatment, the combination of an asthma phenotype and health status based treatment with optimal reduction of environmental factors, is effective in patients with severe allergic and non-allergic uncontrolled asthma.