Page 53 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 53
addressing issues with suboptimal adher- As Specialist difficult asthma care evolves 53
ence to inhaler treatments in conjunction with with the emergence of a wide portfolio of T2
Asthma Specialist Physician, Pharmacist and targeting biologic asthma therapies, so anoth- the multi-disciplinary team approach to specialist adult difficult asthma care
sometimes the Psychologist. er significant role for the Asthma Nurse Spe-
cialist is taking form. This is to supervise the
Self-management is a multicomponent administration of these new agents and often
approach that gives patients the confidence coordinate that with new modalities of treat-
to deal with medical management, role man- ment delivery such as homecare and self-in-
agement and emotional management of their jection. In addition the Asthma Nurse Spe-
chronic health conditions. Use of an asth- cialist is central to monitoring of treatment
ma self-management plan, including regu- response during the initial treatment trial and
lar monitoring of asthma symptoms and lung for assessing continued response thereafter,
function, plus clear guidance on appropriate with surveillance of need for a switch of bi-
management strategies can significantly em- ological therapy should response to the ini-
power patients to take more effective con- tial biologic drug wane over time. These new
trol of their asthma. Specialist Nurses have a biologic agents deliver significant improve-
crucial role in guiding such strategies. A core ments in patient outcome for a majority of pa-
value of self-management in a variable state tients.56-59 One area of opportunity in biologic
like asthma is recognising worsening features responders is to significantly reduce mainte-
and guiding early action. Thus self-manage- nance oral corticosteroid (OCS) burden in a
ment strategies have been shown to improve proportion of previously OCS dependent pa-
asthma control, quality of life while reduc- tients. This has highlighted another impor-
ing exacerbations and acute healthcare us- tant role for the Asthma Nurse Specialist in
age without increasing healthcare costs.50 guiding safe OCS weaning while remaining
observant for features of secondary adreno-
Though self-management should be a core cortical insufficiency.
component of asthma care it is poorly im-
plemented in routine clinical care despite an A further activity that an experienced
unacceptable burden of poor asthma out- Asthma Nurse Specialist can undertake is to
comes.51 Numerous barriers to effective use provide a parallel nurse-led channel of care
with rapid access for designated patients un-
of self-management strategies in asthma are der a difficult asthma MDT. There is limit-
becoming increasingly understood.52 Build- ed definitive evidence on such activity in the
setting of difficult asthma. The role of Asth-
ing on that, development of more versatile ma Nurse Specialists for asthma in gener-
and user-friendly asthma self-management al was highlighted in a comprehensive re-
platforms to aid patients and healthcare pro- view which found no significant differences
fessionals is attracting growing interest and in asthma exacerbations, subsequent asthma
Asthma Nurse Specialists could be integral to severity or quality of life between Nurse-led
their oversight and coordination. In particu- or Physician-led care.60 That concluded that
lar, interest on harnessing interactive technol- Nurse-led care was potentially appropriate
ogies using patient-friendly digital platforms for well-controlled asthma but suggested the
is growing. Studies have reported promising need to establish the evidence base in those
potential, good patient engagement, usability with other levels of asthma control/severi-
and satisfaction with some approaches.53,54,55. ty. An Asthma Nurse Specialist can provide
interim review for patients in between their
Therefore, in the future Asthma Nurse Spe- Physician appointments during periods of
cialists are likely to need to be able to engage clinical instability or where closer observation
with such new technologies and approaches to
undertake their roles within the MDT.
ence to inhaler treatments in conjunction with with the emergence of a wide portfolio of T2
Asthma Specialist Physician, Pharmacist and targeting biologic asthma therapies, so anoth- the multi-disciplinary team approach to specialist adult difficult asthma care
sometimes the Psychologist. er significant role for the Asthma Nurse Spe-
cialist is taking form. This is to supervise the
Self-management is a multicomponent administration of these new agents and often
approach that gives patients the confidence coordinate that with new modalities of treat-
to deal with medical management, role man- ment delivery such as homecare and self-in-
agement and emotional management of their jection. In addition the Asthma Nurse Spe-
chronic health conditions. Use of an asth- cialist is central to monitoring of treatment
ma self-management plan, including regu- response during the initial treatment trial and
lar monitoring of asthma symptoms and lung for assessing continued response thereafter,
function, plus clear guidance on appropriate with surveillance of need for a switch of bi-
management strategies can significantly em- ological therapy should response to the ini-
power patients to take more effective con- tial biologic drug wane over time. These new
trol of their asthma. Specialist Nurses have a biologic agents deliver significant improve-
crucial role in guiding such strategies. A core ments in patient outcome for a majority of pa-
value of self-management in a variable state tients.56-59 One area of opportunity in biologic
like asthma is recognising worsening features responders is to significantly reduce mainte-
and guiding early action. Thus self-manage- nance oral corticosteroid (OCS) burden in a
ment strategies have been shown to improve proportion of previously OCS dependent pa-
asthma control, quality of life while reduc- tients. This has highlighted another impor-
ing exacerbations and acute healthcare us- tant role for the Asthma Nurse Specialist in
age without increasing healthcare costs.50 guiding safe OCS weaning while remaining
observant for features of secondary adreno-
Though self-management should be a core cortical insufficiency.
component of asthma care it is poorly im-
plemented in routine clinical care despite an A further activity that an experienced
unacceptable burden of poor asthma out- Asthma Nurse Specialist can undertake is to
comes.51 Numerous barriers to effective use provide a parallel nurse-led channel of care
with rapid access for designated patients un-
of self-management strategies in asthma are der a difficult asthma MDT. There is limit-
becoming increasingly understood.52 Build- ed definitive evidence on such activity in the
setting of difficult asthma. The role of Asth-
ing on that, development of more versatile ma Nurse Specialists for asthma in gener-
and user-friendly asthma self-management al was highlighted in a comprehensive re-
platforms to aid patients and healthcare pro- view which found no significant differences
fessionals is attracting growing interest and in asthma exacerbations, subsequent asthma
Asthma Nurse Specialists could be integral to severity or quality of life between Nurse-led
their oversight and coordination. In particu- or Physician-led care.60 That concluded that
lar, interest on harnessing interactive technol- Nurse-led care was potentially appropriate
ogies using patient-friendly digital platforms for well-controlled asthma but suggested the
is growing. Studies have reported promising need to establish the evidence base in those
potential, good patient engagement, usability with other levels of asthma control/severi-
and satisfaction with some approaches.53,54,55. ty. An Asthma Nurse Specialist can provide
interim review for patients in between their
Therefore, in the future Asthma Nurse Spe- Physician appointments during periods of
cialists are likely to need to be able to engage clinical instability or where closer observation
with such new technologies and approaches to
undertake their roles within the MDT.
