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Canadian Respiratory Journal
Volume 15 (2008), Suppl B, Pages 1B-19B
Asthma Worsenings Working Group

Asthma Worsenings: Approaches to Prevention and Management from the Asthma Worsenings Working Group

Meyer Balter,1 Pierre Ernst,2 Wade Watson,3 Harold Kim,4 Lisa Cicutto,5 Marie-France Beauchesne,6 Andrew J Cave,7 Alan Kaplan,8 Donna Hogg,9 Andrew McIvor,10 Tom Smiley,11 Michel Rouleau,12 and J Mark FitzGerald13

1University of Toronto, Mount Sinai Hospital, Toronto, Ontario, Canada
2McGill University, Montréal, Québec, Canada
3Department of Pediatrics, Dalhousie University, Division of Allergy, IWK Health Centre, Halifax, Nova Scotia, Canada
4McMaster University, University of Western Ontario, Allergy and Clinical Immunology, Kitchener, Ontario, Canada
5Universities of Toronto and Colorado, National Jewish Medical Research Center, Denver, Colorado, USA
6Faculty of Pharmacy, University of Montréal, Hôpital du Sacré-Coeur de Montréal, Montréal, Québec, Canada
7Department of Family Medicine, University of Alberta, University of Alberta Hospital, Edmonton, Alberta, Canada
8Family Physician Airways Group of Canada, York Central Hospital, Richmond Hill, Ontario, Canada
9College and Association of Registered Nurses of Alberta, Edmonton, Alberta, Canada
10McMaster University, St Joseph’s Healthcare, Firestone Institute for Respiratory Health, Hamilton, Ontario, Canada
11Pharmavision Health Consulting Inc, Paris, Ontario, Canada
12Laval University, Québec, Canada
13Respiratory Division, University of British Columbia, Vancouver General Hospital, Vancouver, British Columbia, Canada

Copyright © 2008 Hindawi Publishing Corporation. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Most asthma patients prescribed maintenance asthma therapies still experience periods of asthma worsenings characterized by daytime or nighttime symptoms, or an increased need for rescue medication. In fact, these episodes are highly prevalent even in patients with well-controlled disease. Published literature suggests that asthma worsenings likely represent a window of opportunity during which patients could intervene early to prevent exacerbations or further deterioration of asthma symptoms. However, current evidence suggests that most patients fail to respond or to self-manage appropriately during these periods.

To address the issue of asthma worsenings, an interdisciplinary committee of respirologists, allergists, family physicians, pharmacists and certified asthma educators from across Canada developed a practical definition of asthma worsenings and provided approaches to the prevention and management of these episodes based on current literature. To date, combination inhaled corticosteroid/long-acting beta-agonist therapy, particularly single inhaler maintenance and reliever therapy, appears to be an effective strategy for preventing asthma worsenings and exacerbations. Addressing the potential barriers to appropriate patient self-management of asthma worsenings, such as failure to adequately identify and respond to worsenings, low expectations for controlling asthma, low health literacy and poor patient-health care professional communication, are also critical to the successful prevention and management of these episodes. Finally, an interdisciplinary team approach involving patients and their families, certified asthma educators, primary care physicians, pharmacists and specialists is likely to have the greatest impact on the identification, prevention and management of asthma worsenings.