Page 45 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 45
e Multi-Disciplinary Team Approach 3.1
to Specialist Adult Difficult Asthma Care
Ramesh J Kurukulaaratchy1,2,3,4 and Chellan Eames4
Abstract 1 Clinical and Experimental
Difficult-to-treat (or difficult) asthma presents a challenging multidimensional model of Sciences, University of
chronic disease that imposes a significant burden at both individual patient and wider societal Southampton, Southampton, UK
levels. Within that model of disease there is increasing understanding of the diverse range of
asthma phenotypes that might be encountered. There is also the growing realisation that these 2 David Hide Asthma and Allergy
do not occur in isolation but exist within a wider multimorbidity disease framework. Identify- Research Centre, Isle of Wight
ing these other treatable traits that exist within the setting of difficult asthma has shown capa- NHS Trust, Isle of Wight, UK
bility to improve patient outcomes. In that context, application of structured approaches to pa-
tient assessment have shown good efficacy, both at more general as well as specialist care levels. 3 NIHR Biomedical Research
So too have multidisciplinary team approaches to difficult asthma care. The combined roles Centre, University Hospitals
of the Asthma Specialist Physician, Asthma Nurse Specialist, Asthma Pharmacist, Speech & Southampton NHS Foundation
Language Therapist and Asthma Dietitian in that regard are evolving rapidly. In this chap- Trust, Southampton, UK
ter we review the multimorbidity model of difficult asthma and how best to approach that
via multi-disciplinary team working approaches when undertaking specialist management of 4 Asthma, Allergy and Clinical
adult difficult asthma in clinical practice. Immunology, University Hospitals
Southampton NHS Foundation
Keywords: difficult asthma, multi-disciplinary team, multimorbidity, treatable traits Trust, Southampton, UK
Introduction – Burden, Disease d ependency, higher treatment needs and po-
Mechanisms, and Definitions of Difficult- tential mortality risk. Though representing a
to-Treat Asthma small proportion of the asthma population,
subjects with more severe disease account for a
Asthma is a common but heterogeneous disproportionate burden imposed by this dis-
chronic inflammatory airway disease respon- ease. They are estimated to account for at least
sible for associated symptoms of breathless- 50% of asthma-associated healthcare costs3.
ness, chest tightness, wheeze and cough. It is Therefore there has been a concerted effort in
estimated to affect over 300 million people recent years to better understand the nature
globally across the life course1. Most people and driving mechanisms behind more severe
with asthma can attain good disease control asthma and develop effective treatments for it.
with standard inhaled therapies administered
in line with conventional guideline-based ap- Our current pharmacotherapeutic ap-
proaches2. However, around 5-10% of peo- proach to asthma is moulded to the Type 2 (T2)
ple with asthma have more complex and inflammation pathophysiological paradigm
difficult-to-control disease that is associat- of asthmatic disease. This concept of “T2-
ed with greater disease morbidity, healthcare high” and “T2-low” asthma inflammatory
https://doi.org/10.26 493/978 -961-293 -157-5.45 - 65
to Specialist Adult Difficult Asthma Care
Ramesh J Kurukulaaratchy1,2,3,4 and Chellan Eames4
Abstract 1 Clinical and Experimental
Difficult-to-treat (or difficult) asthma presents a challenging multidimensional model of Sciences, University of
chronic disease that imposes a significant burden at both individual patient and wider societal Southampton, Southampton, UK
levels. Within that model of disease there is increasing understanding of the diverse range of
asthma phenotypes that might be encountered. There is also the growing realisation that these 2 David Hide Asthma and Allergy
do not occur in isolation but exist within a wider multimorbidity disease framework. Identify- Research Centre, Isle of Wight
ing these other treatable traits that exist within the setting of difficult asthma has shown capa- NHS Trust, Isle of Wight, UK
bility to improve patient outcomes. In that context, application of structured approaches to pa-
tient assessment have shown good efficacy, both at more general as well as specialist care levels. 3 NIHR Biomedical Research
So too have multidisciplinary team approaches to difficult asthma care. The combined roles Centre, University Hospitals
of the Asthma Specialist Physician, Asthma Nurse Specialist, Asthma Pharmacist, Speech & Southampton NHS Foundation
Language Therapist and Asthma Dietitian in that regard are evolving rapidly. In this chap- Trust, Southampton, UK
ter we review the multimorbidity model of difficult asthma and how best to approach that
via multi-disciplinary team working approaches when undertaking specialist management of 4 Asthma, Allergy and Clinical
adult difficult asthma in clinical practice. Immunology, University Hospitals
Southampton NHS Foundation
Keywords: difficult asthma, multi-disciplinary team, multimorbidity, treatable traits Trust, Southampton, UK
Introduction – Burden, Disease d ependency, higher treatment needs and po-
Mechanisms, and Definitions of Difficult- tential mortality risk. Though representing a
to-Treat Asthma small proportion of the asthma population,
subjects with more severe disease account for a
Asthma is a common but heterogeneous disproportionate burden imposed by this dis-
chronic inflammatory airway disease respon- ease. They are estimated to account for at least
sible for associated symptoms of breathless- 50% of asthma-associated healthcare costs3.
ness, chest tightness, wheeze and cough. It is Therefore there has been a concerted effort in
estimated to affect over 300 million people recent years to better understand the nature
globally across the life course1. Most people and driving mechanisms behind more severe
with asthma can attain good disease control asthma and develop effective treatments for it.
with standard inhaled therapies administered
in line with conventional guideline-based ap- Our current pharmacotherapeutic ap-
proaches2. However, around 5-10% of peo- proach to asthma is moulded to the Type 2 (T2)
ple with asthma have more complex and inflammation pathophysiological paradigm
difficult-to-control disease that is associat- of asthmatic disease. This concept of “T2-
ed with greater disease morbidity, healthcare high” and “T2-low” asthma inflammatory
https://doi.org/10.26 493/978 -961-293 -157-5.45 - 65
