Managing difficult-to-treat asthma: Lessons from a center of excellence in allergy and asthma care.

One in four asthma patients may not have their condition adequately controlled despite being treated according to current practice guidelines, and these patients experience persistent symptoms, frequent exacerbations, and high healthcare utilization. The Allergy and Asthma Center, a recognized center of excellence in the treatment of allergy and asthma, is based on a patient-first philosophy, and this article explains how the practice operates and the importance of maintaining efficient office flow, implementing technology, and building a caring and dedicated staff Because asthma patients are often referred from primary care physicians, many present with difficult-to-treat disease. Even though many of these patients have received inhaled corticosteroids either alone or in combination with other medications, their condition still remains not well controlled. Serum total immunoglobulin E (IgE) is commonly elevated in patients with dfficult-to-treat asthma, and consequently, the IgE blocker omalizumab may be a viable option in this setting.