Page 49 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 49
avioural traits include poor inhaler tech- comorbidities in such patients. That in turn 49
nique, poor treatment adherence, distort- has been accompanied by an increasing focus
ed symptom perception and smoking. A core on multidisciplinary team (MDT) models of the multi-disciplinary team approach to specialist adult difficult asthma care
purpose of this structured approach of identi- care centred around a systematic assessment
fying treatable traits is to acknowledge the un- process in order to meet the diverse support
derlying complexity of clinical presentation in needs of this patient group. Such structured
a manner that facilitates more precise asthma models of care will inevitably vary according
management which is personalised and ho- to healthcare system and available resource.
listic. This a notable shift from the “one size This structured approach lends itself particu-
fits all” approach encouraged by traditional larly well to implementation via specialist care
guideline-based management strategies that centres for patients with difficult asthma. In
have been the mainstay of clinical manage- countries such as the UK this approach has
ment in recent decades. been further aligned to a process of region-
al specialist centres for difficult asthma sup-
Treatable traits are common in diffi- porting regional networks of care29. These
cult asthma where they may cluster to varia- centres must meet specified resource require-
ble degrees in individual patients.16,17,24-26 One ments and are subject to quality benchmark-
study indicated a median number of 3 comor- ing on core outcomes. While the UK spe-
bidities per patient attending a specialist-re- cialist commissioned framework offers one
ferral difficult asthma clinic in Melbourne, systematic approach, data has consistently
Australia.27 Of note, the burden of treatable shown that comprehensive assessment with-
traits appears to align with worse asthma out- in more specialised difficult asthma care re-
comes such as exacerbations, asthma control alises improvements in patient asthma status
and quality of life.17,23,25 Conversely systematic regardless of geography or healthcare sys-
clinical approaches that incorporate address- tem.27,30,31 Thus a 3 step systematic approach
ing treatable traits in asthma has also recently to difficult asthma specialist care based on
shown clinical effectiveness in improving out- diagnostic confirmation, comorbidity detec-
comes for this patient group.27,28 This model of tion and inflammatory phenotyping was as-
difficult asthma as a Difficult Breathing Syn- sessed in Melbourne, Australia.30 This result-
drome with numerous treatable traits further ed in significant improvements in comorbid
stimulates the need to engage a systematic ap- conditions like chronic rhinosinusitis and dys-
proach to assess and manage such patients functional breathing. It also resulted in signif-
and take into account multi-disciplinary ap- icant parallel improvements in asthma relat-
proaches based on individual patient need. ed outcomes such as asthma control, asthma
related quality of life and exacerbation fre-
Structured Multi-Disciplinary Team quency. Further work from the same research
Approaches to Difficult Asthma Care group has more closely focused on asthma pa-
tient-related outcome measures.31 This found
The recognition of difficult asthma as typical- that a systematic assessment framework in
ly constituting a multimorbidity disease model difficult asthma specialist care realized sig-
alongside the growing portfolio of higher level nificant improvements across multiple asthma
biologic medications has led to a growing con- domains. These included a halving of main-
sensus that there is a need to adopt an increas- tenance oral corticosteroid dose (regardless
ingly structured and holistic approach to care of biologic co-administration) and achieve-
for patients with difficult asthma.13,29 A key ment of minimally important differences for
advancement that has accompanied that con- asthma symptom control and quality of life
sensus has been to both address the asthmat-
ic component as well as relevant aggravating
nique, poor treatment adherence, distort- has been accompanied by an increasing focus
ed symptom perception and smoking. A core on multidisciplinary team (MDT) models of the multi-disciplinary team approach to specialist adult difficult asthma care
purpose of this structured approach of identi- care centred around a systematic assessment
fying treatable traits is to acknowledge the un- process in order to meet the diverse support
derlying complexity of clinical presentation in needs of this patient group. Such structured
a manner that facilitates more precise asthma models of care will inevitably vary according
management which is personalised and ho- to healthcare system and available resource.
listic. This a notable shift from the “one size This structured approach lends itself particu-
fits all” approach encouraged by traditional larly well to implementation via specialist care
guideline-based management strategies that centres for patients with difficult asthma. In
have been the mainstay of clinical manage- countries such as the UK this approach has
ment in recent decades. been further aligned to a process of region-
al specialist centres for difficult asthma sup-
Treatable traits are common in diffi- porting regional networks of care29. These
cult asthma where they may cluster to varia- centres must meet specified resource require-
ble degrees in individual patients.16,17,24-26 One ments and are subject to quality benchmark-
study indicated a median number of 3 comor- ing on core outcomes. While the UK spe-
bidities per patient attending a specialist-re- cialist commissioned framework offers one
ferral difficult asthma clinic in Melbourne, systematic approach, data has consistently
Australia.27 Of note, the burden of treatable shown that comprehensive assessment with-
traits appears to align with worse asthma out- in more specialised difficult asthma care re-
comes such as exacerbations, asthma control alises improvements in patient asthma status
and quality of life.17,23,25 Conversely systematic regardless of geography or healthcare sys-
clinical approaches that incorporate address- tem.27,30,31 Thus a 3 step systematic approach
ing treatable traits in asthma has also recently to difficult asthma specialist care based on
shown clinical effectiveness in improving out- diagnostic confirmation, comorbidity detec-
comes for this patient group.27,28 This model of tion and inflammatory phenotyping was as-
difficult asthma as a Difficult Breathing Syn- sessed in Melbourne, Australia.30 This result-
drome with numerous treatable traits further ed in significant improvements in comorbid
stimulates the need to engage a systematic ap- conditions like chronic rhinosinusitis and dys-
proach to assess and manage such patients functional breathing. It also resulted in signif-
and take into account multi-disciplinary ap- icant parallel improvements in asthma relat-
proaches based on individual patient need. ed outcomes such as asthma control, asthma
related quality of life and exacerbation fre-
Structured Multi-Disciplinary Team quency. Further work from the same research
Approaches to Difficult Asthma Care group has more closely focused on asthma pa-
tient-related outcome measures.31 This found
The recognition of difficult asthma as typical- that a systematic assessment framework in
ly constituting a multimorbidity disease model difficult asthma specialist care realized sig-
alongside the growing portfolio of higher level nificant improvements across multiple asthma
biologic medications has led to a growing con- domains. These included a halving of main-
sensus that there is a need to adopt an increas- tenance oral corticosteroid dose (regardless
ingly structured and holistic approach to care of biologic co-administration) and achieve-
for patients with difficult asthma.13,29 A key ment of minimally important differences for
advancement that has accompanied that con- asthma symptom control and quality of life
sensus has been to both address the asthmat-
ic component as well as relevant aggravating
