Bridging the evidence–practice gap in asthma management

: real world adherence patterns, patient and clinician perspectives, and clinical modelling

Abstract

Asthma is a long-term allergic and inflammatory respiratory condition that impacts approximately 300 million individuals globally, contributing to morbidity, mortality, and healthcare costs. However, despite the increased understanding of the underlying immunopathology of asthma and advances in therapeutic modalities, it remains a considerable global health burden.
The United Kingdom Clinical Practice Research Datalink (UKCPRD) database analysis and the Asthma Patients’ and Physicians’ Perspectives on the Burden and Management of Asthma (APPaRENT) studies provide important insights into the behaviour of patients and clinicians related to asthma management and highlight important gaps in evidence-based adherence to guidelines.
Pharmacokinetic/ pharmacodynamic (PK/PD) modelling investigations enhance our understanding of dosing regimens focusing on increased adherence and, in cases where this is not achievable, targeting optimal dosing regimens for patients with low adherence to ensure their asthma is better managed. The Delphi study emphasizes the necessity for modelling studies to be integrated into clinical practice and the need for education of prescribers on the clinical implementation of this research to better inform asthma management and improve patient outcomes.
Our research emphasizes the need for personalized treatment approaches based on individual patient characteristics and adherence patterns. Using clinical modelling studies, we provide examples to show that regular maintenance dosing yields effective bronchoprotection and that long-acting inhaled corticosteroid (ICS)molecules provide a greater efficacy in situations of low adherence. This research highlights the importance of continued clinician and patient education, periodic assessments, and individualized interventions to enhance adherence and optimize asthma management.
This thesis demonstrates that poor asthma outcomes are driven less by therapeutic limitations and more by failures in adherence including implementation, and behavioural alignment in routine care. Using large-scale real-world data and multinational patient and clinician surveys, this work provides novel evidence characterising real-world adherence behaviours and perceptual gaps and uniquely links these behavioural patterns to clinical risk through pharmacokinetic/pharmacodynamic modelling. By integrating these approaches, the thesis shows that meaningful asthma control is achievable at realistic adherence thresholds (approximately 70–80%) when treatment regimens are appropriately designed. Applying behavioural frameworks (COM-B and the Necessity–Concerns Framework (NCF) as a translational tool, this work advances current knowledge by proposing practice-ready strategies to bridge the evidence–practice gap in asthma management.

Date of Award	Sept 2026
Original language	English
Awarding Institution	University of Brighton
Supervisor	Alison Lansley (Supervisor) & Sian Williams (Supervisor)