Page 50 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
P. 50
in over 50% patients. Reduced exacerbations registries and access to relevant supporting re-
were found in 64% patients while 40% pa- sources. A structured electronic template to
severe asthma forum 1: severe asthma - basic and clinical views tients improved their FEV1 by ≥ 100ml. Im- guide severe asthma systematic evaluation
provement in at least domain was found in has also been recently created in the form of
87% of patients undergoing that systemat- SAGE (Severe Asthma Global Evaluation) to
ic assessment. Of note, the improvements encourage consistency in the systematic as-
demonstrated in this study were independent sessment process34. It contains up to 282 input
of biologic treatment initiation, highlighting fields but utilises auto-calculations and deci-
the value of early adoption of such approach- sion making tools to streamline the process.
es in the patient care pathway to ensure focus-
ing the right treatments on the right patients, The case to base difficult asthma care
at the right time. In that context, structured on a systematic multidisciplinary assessment
assessment can be applied at different points framework seems entirely logical and well
along the asthma care pathway, not just in a supported by an emerging evidence base as
specialist centre environment. SIMPLES was discussed above. However, that approach
introduced as a tool for use in primary care to is not without potential difficulties at mul-
support management of patients with poorly tiple levels as recently highlighted by Majel-
controlled asthma.32 The SIMPLES approach lano et al.35 These problems might be down to
encompassed self-management, education, the physician with poor adherence to guide-
monitoring, lifestyle (with emphasis on smok- lines and checklists, alongside underuse of di-
ing status) in addition to pharmacotherapy. agnostic tests and available referral pathways.
The specific assessment domains in SIMPLES They may also reflect issues of communica-
comprised smoking status, inhaler technique, tion and different perceptions of management
monitoring, pharmacotherapy, lifestyle, edu- goals between physician and patient. A re-
cation and support. Often ignored facets such cent US study further emphasized the poten-
as regular review and accessibility were also tial discordance in recognition of asthma con-
recognised and given prominence. This was trol between physician and patient. Of note it
coupled to guidance on when to refer from demonstrated a tendency for under perception
primary to specialist care. Another important of symptoms and asthma control by patients
component to SIMPLES was the early adop- when assessed by parameters such as Asthma
tion of digital technologies with web-based Control Test or GINA asthma control crite-
access to both the SIMPLES framework and ria.36 Other critical barriers to optimal multi-
relevant assessment tools. More recently the disciplinary assessment and care may also oc-
Severe Asthma Toolkit was developed as a cur at an organisational/resource level with
holistic resource to support structured multi- inadequate clinical staffing, clinical space and
disciplinary care for patients with severe asth- capacity. Such factors may place limitations
ma across the healthcare spectrum.33 Devel- on access to both assess, review and treat pa-
oped by a consortium of multidisciplinary tients in a timely and ideal fashion.
experts with patient and advocate codesign,
this resource was established in the format of The MDT Components of Specialist
an easily accessible website. Content included Difficult Asthma Care in a Specialist
background information about severe asth- Clinic
ma, diagnosis and assessment, management,
medications, comorbidities, living with severe InaSpecialistclinicsetting,theassembledMDT
asthma, information on establishing a clini- typically will include a range of healthcare
cal service, specifics to paediatric and adoles- professionals including Consultant Respirato-
cent care, advice on specific population needs, ry Physicians, Consultant Allergists, Asthma
Nurse Specialists, Asthma Physiotherapists,
were found in 64% patients while 40% pa- sources. A structured electronic template to
severe asthma forum 1: severe asthma - basic and clinical views tients improved their FEV1 by ≥ 100ml. Im- guide severe asthma systematic evaluation
provement in at least domain was found in has also been recently created in the form of
87% of patients undergoing that systemat- SAGE (Severe Asthma Global Evaluation) to
ic assessment. Of note, the improvements encourage consistency in the systematic as-
demonstrated in this study were independent sessment process34. It contains up to 282 input
of biologic treatment initiation, highlighting fields but utilises auto-calculations and deci-
the value of early adoption of such approach- sion making tools to streamline the process.
es in the patient care pathway to ensure focus-
ing the right treatments on the right patients, The case to base difficult asthma care
at the right time. In that context, structured on a systematic multidisciplinary assessment
assessment can be applied at different points framework seems entirely logical and well
along the asthma care pathway, not just in a supported by an emerging evidence base as
specialist centre environment. SIMPLES was discussed above. However, that approach
introduced as a tool for use in primary care to is not without potential difficulties at mul-
support management of patients with poorly tiple levels as recently highlighted by Majel-
controlled asthma.32 The SIMPLES approach lano et al.35 These problems might be down to
encompassed self-management, education, the physician with poor adherence to guide-
monitoring, lifestyle (with emphasis on smok- lines and checklists, alongside underuse of di-
ing status) in addition to pharmacotherapy. agnostic tests and available referral pathways.
The specific assessment domains in SIMPLES They may also reflect issues of communica-
comprised smoking status, inhaler technique, tion and different perceptions of management
monitoring, pharmacotherapy, lifestyle, edu- goals between physician and patient. A re-
cation and support. Often ignored facets such cent US study further emphasized the poten-
as regular review and accessibility were also tial discordance in recognition of asthma con-
recognised and given prominence. This was trol between physician and patient. Of note it
coupled to guidance on when to refer from demonstrated a tendency for under perception
primary to specialist care. Another important of symptoms and asthma control by patients
component to SIMPLES was the early adop- when assessed by parameters such as Asthma
tion of digital technologies with web-based Control Test or GINA asthma control crite-
access to both the SIMPLES framework and ria.36 Other critical barriers to optimal multi-
relevant assessment tools. More recently the disciplinary assessment and care may also oc-
Severe Asthma Toolkit was developed as a cur at an organisational/resource level with
holistic resource to support structured multi- inadequate clinical staffing, clinical space and
disciplinary care for patients with severe asth- capacity. Such factors may place limitations
ma across the healthcare spectrum.33 Devel- on access to both assess, review and treat pa-
oped by a consortium of multidisciplinary tients in a timely and ideal fashion.
experts with patient and advocate codesign,
this resource was established in the format of The MDT Components of Specialist
an easily accessible website. Content included Difficult Asthma Care in a Specialist
background information about severe asth- Clinic
ma, diagnosis and assessment, management,
medications, comorbidities, living with severe InaSpecialistclinicsetting,theassembledMDT
asthma, information on establishing a clini- typically will include a range of healthcare
cal service, specifics to paediatric and adoles- professionals including Consultant Respirato-
cent care, advice on specific population needs, ry Physicians, Consultant Allergists, Asthma
Nurse Specialists, Asthma Physiotherapists,
