Outpatient follow-up of patients with asthma by a primary care physician. Guidelines

Most patients with asthma respond well to treatment, but some of them have a disease that is difficult to control. This may be due to a number of factors, such as the presence of triggers (allergens, smoking, etc.), disease phenotype, severe airway remodeling (and, as a result, fixed obstruction), low adherence to treatment, and improper inhalation technique. Such patients have a high frequency of exacerbations and requests for care, risk of complications. In addition, patients with asthma of any course, including mild, may have severe exacerbations. Outpatient follow-up of patients is the main approach to the prevention and early diagnosis of exacerbations, complications and progression of the disease, and the implementation of medical rehabilitation. The guidelines describe the algorithm for outpatient appointment of patients with asthma by a primary care physician and supporting materials.

The guidelines are intended for district internists, general practitioners (family doctors), district internists of the shop medical district, as well as for secondary medical personnel working with these doctors, for paramedics of paramedic-o bstetric stations (paramedic health centers) in case they are assigned the functions of the attending physician.

The guidelines can be used by public health physicians, heads of primary health care facilities and their divisions.

1. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. 2022 Prevention of chronic non-communicable diseases in the Russian Federation. National guidelines. Cardiovascular Therapy and Prevention. 2022;21(4):3235. (In Russ.)

2. Dispensary monitoring of patients with chronic non-communicable diseases and patients at high risk of their development. Methodological recommendations. Edited by S. A. Boitsov and A. G. Chuchalin. Moscow: 2014, 112 p. (In Russ.)

3. Drapkina OM, Kontsevaya AV, Kalinina AM, et al. Comorbidity of patients with noncommunicable diseases in general practice. Eurasian guidelines. Cardiovascular Therapy and Prevention. 2024;23(3):3996. (In Russ.)

4. Bateman ED, Price DB, Wang HC, et al. Short-acting β2-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J. 2022;59(5):2101402. doi:10.1183/13993003.01402-2021.

5. Avdeev S, Voznesenskiy N, Boldina M, et al. Beekman MJHI. SABA Overuse in Russia — Burden and Possible Causes: An Analysis of the Russian Population in the SABINA III (SABA use IN Asthma) Study. J Asthma Allergy. 2022;15:371–379. doi:10.2147/JAA.S350393.

6. Smirnova MI, Antipushina DN, Kontsevaya AV, Drapkina OM. An analytical review of the role of respiratory infections in patients with chronic obstructive pulmonary disease and bronchial asthma. Part 1. Characteristics of respiratory infections and their long-term consequences. Preventive medicine. 2024;27(1):90–6. (In Russ.)

7. Smirnova MI, Antipushina DN, Kontsevaya AV, Drapkina OM. An analytical review of the role of respiratory infections in patients with chronic obstructive pulmonary disease and bronchial asthma. Part 2. Prevention of the occurrence and severe course of respiratory infections. Preventive medicine. 2024;27(2):103– 10. (In Russ.)

8. Otorhinolaryngology: a national guide in 3 volumes. Edited by A. Daikhes, Yu. K. Yanova; executive editor I. A. Kim. Moscow: Publishing house "Editorial Board", 2024. (In Russ.)

9. Boytsov SA, Pogosova NV, Ansheles AA, et al. Cardiovascular prevention 2022. Russian national guidelines. Russian Journal of Cardiology. 2023;28(5):5452. (In Russ.)

10. Astanina SYu, Kalinina AM, Shepel RN, Drapkina OM. Methodological recommendations for the preparation of doctors for short preventive counseling. Textbook. Moscow: FSBI "NMITS TPM", 2023. 52 p. (In Russ.)

11. Drapkina OM, Drozdova LYu, Kalinina AM, et al. Organization of preventive medical examination and medical examination of certain groups of the adult population. Methodological recommendations. 2nd edition: Federal State Budgetary Institution "NMITS TPM" of the Ministry of Health of the Russian Federation, 2020. 232 p. (In Russ.)

12. Gorbunov VM, Smirnova MI, Kurekhyan AS, Drapkina OM. Evaluation of office and ambulatory blood pressure in the practice of a primary care physician. Guidelines. Cardiovascular Therapy and Prevention. 2023;22(7):3666. (In Russ.)

13. Schatz M, Sorkness CA, Li JT, et al. Asthma Control Test: reliability, validity, and responsiveness in patients not previously followed by asthma specialists. J. Allergy Clin. Immunol. 2006;117:549–56.

14. Schatz M, Mosen DM, Kosinski M, et al. Validity of the Asthma Control Test completed at home. Am. J. Manag.Care. 2007;13:661–7.

15. Meltzer EO, Busse WW, Wenzel SE, et al. Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol. 2011;127(1):167–72. doi:10.1016/j.jaci.2010.08.042.

16. De VA, Kochetkov AI, Kogai VV, et al. Drug-induced asthma exacerbations and bronchospasm. Lechebnoe delo. 2021;4:17–23. (In Russ.)

17. Current inhalational devices for treatment of respiratory disease. Task Force report of European Respiratory Society and the International Societyfor Aerosols in Medicine. Pulmonologiya. 2011;(6):17–41. (In Russ.)

18. Drapkina OM, Briko NI, Kostinov MP, et al. Immunization of adults. Methodological recommendations. Moscow, Federal State Budgetary Institution "NMITS TPM" of the Ministry of Health of Russia: 2020. 248 p. (In Russ.)

19. Avdeev SN, Alieva MH, Baranov AA, et al. Vaccinoprophylaxis of pneumococcal infection in children and adults. Methodological recommendations. Preventive medicine. 2023;26(9), Appendix:3–23. (In Russ.)

20. Kostinov MP. Adult vaccination — from strategy to tactics. A guide for doctors. Moscow: MDV Group, 2020. 248 p. (In Russ.)

21. Ridda I, Yin JK, King C, et al. The Importance of Pertussis in Older Adults: A Growing Case for Reviewing Vaccination Strategy in the Elderly. Vaccine. 2012;30(48):6745–52.

22. Kobalava ZhD, Konradi AO, Nedogoda SV, et al. 2024 Clinical practice guidelines for Hypertension in adults. Russian Journal of Cardiology. 2024;29(9):6117. (In Russ.)

23. Svinin GE, Kutsenko VA, Shalnova SA, et al. Validation of SCORE2 on a sample from the Russian population and adaptation for the very high cardiovascular disease risk region. PLOS ONE. 2024;19(4): e0300974. doi:10.1371/journal.pone.0300974.

24. Holland AE, Spruit MA, Troosters T. An official European Respiratory Society/American Thoracic Society technical standard: field walking tests in chronic respiratory disease. Eur Respir J. 2014;44(6):1428–46. doi:10.1183/09031936.00150314.

25. Borg GAV. Psycho-physical bases of perceived exertion. Med Sci Sports Exerc. 1982;14:377–81.

26. Bitter NV, Prudnikova NG, Pozdnikova NN, Metelev AV. Sanatorium and resort service: a textbook for students of the direction 43.04.01 Service, profile "Management of sanatorium and resort business". edited by N. V. Bitter, N. G. Prudnikova; Ministry of Science and Higher Education of the Russian Federation, Altai State University. Barnaul: Publishing house of the Alt. University, 2024. 174 p. (In Russ.)