A guide for a patient-centric approach to asthma management: results of a European Delphi consensus programme

NPJ primary care respiratory medicine · 2025 · DACH

Source and licence

Authors: Fulvio Braido, Ilaria Baiardini, Simona Barbaglia et al.
Title: A guide for a patient-centric approach to asthma management: results of a European Delphi consensus programme
Journal: NPJ Primary Care Respiratory Medicine, 2025
DOI: 10.1038/s41533-025-00465-3
Licence: CC BY 4.0
Changes: Verbatim excerpts; formatting adapted

Full text retrieved 2026-10-27 from Europe PMC · PMC12770437

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Recommendations

Verbatim, with grade of recommendation or strength of consensus where given.

Voting

Treatment should fit a patient’s daily life and be personalised. Problems like cost, trouble using the inhaler and beliefs about asthma or inhalers need to be considered. This will help patients use their inhalers regularly and correctly.
Doctors/nurses and patients should work together to find out how asthma affects the patient’s life. They should also discuss why asthma control is important for their short- and long-term goals of treatment. This will make sure that patients use their inhaler regularly and are happy with it.
Correct inhaler technique and the ability to breathe in strongly are key for deciding between dry powder inhalers (DPIs) and metered-dose inhalers (MDIs). DPIs are not right for patients who can’t inhale strongly enough.
Patients’ understanding of asthma and why they need an inhaler can differ. Doctors/nurses should check what patients know about why they need treatment and give them the right information and education if needed. This helps choose the best treatment and encourages regular use.
What patients know, believe and have experienced about how well asthma inhalers work and how safe they are can affect if they use them as suggested. Doctors/nurses should ask patients to share their thoughts and worries about inhalers, so any confusion or concerns can be cleared up.
Any reasons why a patient might not follow their treatment should be discussed openly. A team approach helps find and fix any problems, leading to better asthma control.
Including patients in decisions about their asthma treatment can lead to better results. It can help them stick to their treatment if it is right for them, and it fits their needs and lifestyle.
How easy the inhaler is to use and the right technique can affect if a patient is satisfied and follows their treatment. Doctors/nurses should provide training and agree with their patient on the right device for them.
Choosing the right inhaler should consider both the medicine and practical things, like portability and a dose counter. This helps make sure the treatment fits the patient’s needs in both aspects.
Some patients prefer using just one inhaler instead of two or more. Doctors/nurses should take this into account to plan a patient’s treatment. It can help to improve patient satisfaction and make it easier for them to stick to their treatment.
Some patients have concerns about non-branded inhalers compared with brand name ones. Doctors/nurses should address these concerns when they choose a non-branded inhaler to make sure patients follow their treatment.
Doctors/nurses should teach their patients about different inhalers, how to use them, and their risks and benefits. This helps to decide on a treatment together and can improve how well patients follow their treatment.
Doctors/nurses and patients should agree on what good asthma control looks like and how to reach it. This shared understanding of treatment goals helps with better asthma care.
Treatment goals should be reviewed at each visit to make sure both the patient and provider are working towards the same goals.
Both the doctor/nurse and patient should agree on a treatment plan. This makes sure the plan meets the patient’s needs, leading to better results and regular use of the treatment.
Doctors/nurses can use tools like the RACE questionnaire to find out what might make it hard for a patient to stick to their inhaler treatment.
There are many apps and tools that can help patients check if they are using their inhaler properly and often enough. Doctors/nurses should assess each individual patient and, if appropriate, suggest apps or tools that might help them.
Patients should get treatment or self-management plans in writing, either electronically (so they can print them) or on paper.

Abstract

Background: The Global Initiative for Asthma 2024 report recommends a shared decision-making approach to guide treatment choice, encompassing patients’ goals, beliefs and concerns about asthma and medications (GINA. Global Strategy for Asthma Management and Prevention, 2024). There is limited guidance on ways to achieve this goal. This consensus programme aimed to create recommendations on optimal selection of inhaler treatment while considering patient perspectives and needs. Methods: A literature review was conducted on literature published between 01/01/2014 and 23/04/2024 using agreed keywords and search parameters in PubMed and Cochrane databases. Evidence on impact of patient factors on adherence and asthma control, plus inhaler preference data, was analysed. A consensus voting panel was selected via screening questionnaire, with 50 patients with asthma duration ≥5 years and 39 healthcare professionals with expertise in asthma from five European countries (Germany, France, Czechia, Italy, Greece). A two-round Delphi method was used. Results: 40/135 papers were considered relevant. From these, 20 consensus statements were developed in four areas: patient-centred treatment selection, medication/asthma beliefs, patient preference + shared decision-making, and tools for patient-centred care. 18/20 consensus statements were accepted with an agreement threshold >85% on the first round of voting. Two revised statements underwent a second Delphi round, again failing to reach consensus. Conclusions: This important initiative generated much-needed guidance on integrating patient views and needs into treatment decision-making following a well-established methodology through 18 consensus statements, with nearly equal input from patients and healthcare professionals.

Contents of the original publication

The section headings of the original.

Introduction
Methods
Panel formation
Literature search
Consensus voting
Data analysis
Results
Literature search
Voting
Discussion

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