ERS satellite, March 2026
ASTHMA
A Patient-centred approach to understanding the spectrum of asthma management
Speaker
Professor António Jaime Correia De Sousa
The Evidence for Supported Self-Management in asthma is overwhelming
Asthma care is evolving. While pharmacological innovation remains central, there is growing recognition that outcomes are determined as much by behavior and support structures as by molecules themselves. Two key publications1,2 help outline what actions are needed in asthma care, and how to integrate those actions in routine practice.
Nicolai Krogh
Medical advisor, Chiesi Nordic
Delphi consensus and insights on implementation
Two complementary publications help clarify the path forward: the European Delphi consensus on patient-centred asthma management by Braido et al.1 and the landmark implementation review on supported self-management by Pinnock et al. Together, they outline both what should be done and how it can be embedded into routine practice.2
Self-management is linked to better clinical outcomes
The systematic review by Pinnock and colleagues synthesised RCT and implementation evidence on supported self-management in asthma. The conclusions were clear: when patients receive education, written action plans, and regular professional review, clinical outcomes improve substantially.2
Supported self-management was associated with:
- Reductions in hospitalisations and emergency care
- Improved asthma control
- Reduced morbidity
- Signals towards reduced mortality
- Consistent reductions in healthcare utilisation
Importantly, these benefits were not confined to controlled research environments. The review demonstrated that supported self-management can be implemented effectively in routine clinical practice.
Professor De Sousa argued that self-management should not be considered an optional enhancement but a core, expected component of high-quality asthma care.
From principle to practice: the Delphi consensus
While guidelines such as GINA advocate shared decision-making,3 operational clarity has often been lacking. The 2026 European Delphi programme addressed this gap by bringing together 50 patients and 39 experienced healthcare professionals from five European countries.1 Using a structured methodology with an >85% agreement threshold, the panel reached consensus on 18 statements across four domains1:
| Patient-centred treatment selection | Medication and asthma beliefs |
| Shared decision-making and patient preferences | Use of tools and technology to support care |
The results provide practical guidance on what patient-centred care looks like in daily consultations and underline the necessity to fit a treatment into the patient’s daily life.
What asthma management should include
Asthma management should incorporate:
- Exploration of how asthma affects the individual
- Clarification of treatment goals
- Discussion of inhaler preferences and usability
- Open dialogue about concerns, including safety and generics
- Assessment of adherence barriers without judgement
The consensus reinforces that correct inhaler technique, device suitability, and patient capability must inform inhaler choice, not merely formulary habit.
Adherence is a communication and alignment challenge
Both the implementation evidence and the European Delphi consensus converge on a fundamental insight: 1,2 adherence is not a compliance problem – it is a communication and alignment challenge. Patients’ beliefs about necessity, safety, stigma or dependence directly shape how they use their medication. When these perspectives are not explored, underuse of anti-inflammatory therapy, poor control and preventable exacerbations inevitably follow.
Use existing tools to move beyond good intentions
Operationalising patient-centred care requires structure. Written asthma action plans, regular review of treatment goals, structured assessment of adherence barriers, and appropriate use of digital tools transform good intentions into routine practice. These measures move care beyond prescribing toward genuine partnership.
This represents a broader cultural shift. Asthma management must evolve from a prescriber-led escalation model to a longitudinal collaboration where clinical evidence, device usability, patient capability, personal goals and system support are aligned. Pharmacological potency alone cannot compensate for poor technique, inconsistent use or misaligned expectations.
Supported self-management: deliver, monitor, teach – and measure quality
Importantly, this responsibility extends beyond individual consultations. Supported self-management should be routinely delivered, monitored, embedded in professional training and recognised within quality frameworks. Given the consistent evidence that self-management reduces healthcare utilisation, implementation is not only clinically justified but economically rational.
The direction is clear: asthma outcomes will improve when shared decision-making becomes structured practice, each patient has an individualised action plan, inhaler choice is individualised, and follow-up is systematic. Patient-centred asthma care is no longer an aspiration – it is an evidence-based imperative.
Nicolai Krogh
Medical Advisor, Chiesi Nordic
References
- Braido F, Baiardini I, Barbaglia S, Palkonen S, Ruiz A, Tsiligianni I, Virchow JC, Winders T. A guide for a patient-centric approach to asthma management: results of a European Delphi consensus programme. NPJ Prim Care Respir Med. 2025 Dec 19;36(1):2.
- Pinnock H, Epiphaniou E, Pearce G, Parke H, Greenhalgh T, Sheikh A, Griffiths CJ, Taylor SJ. Implementing supported self-management for asthma: a systematic review and suggested hierarchy of evidence of implementation studies. BMC Med. 2015 Jun 1;13:127.
- Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention, 2025. Available from: https://www.ginasthma.org.
ID 20195-11.03.2026