Page 58 - Škrgat, Sabina, ed. 2022. Severe Asthma - Basic and Clinical Views. Koper: University of Primorska Press. Severe Asthma Forum, 1
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improvements in quality of life, asthma con- a framework that can be adapted for future
trol and anxiety levels, though wider effects pathways in difficult asthma.113
severe asthma forum 1: severe asthma - basic and clinical views could not be discerned. Additionally incon-
sistent study methodology reduced the degree Impact of Combined Difficult Asthma
to which these results could be interpreted.108 MDT Approaches
A case series from UK difficult asthma cen-
tres illustrated the potential individual patient The multimorbid nature of difficult asthma
benefits that can be obtained using CBT in- ideally requires an integrated MDT approach
terventions.109 to properly address the constituent parts. Sig-
nificant benefits from such an approach have
A potential role for the Asthma Psy- recently been demonstrated utilising a struc-
chologist within a multidimensional interven- tured assessment to identify treatable traits,
tion is indicated by the recent demonstration aligned with appropriate MDT involvement
of a clustering of extrapulmonary comorbidi- that was coordinated by a nurse case manag-
ties in difficult asthma patients with very poor er.28 These included improvements in quality
asthma control. These included psychological of life, asthma control and acute primary care
factors such as depression and anxiety plus asthma visits. Previously an integrated MDT
obesity and physical inactivity.24 Adequate approach was established by our Institution
Psychologist resource and time to support the when initiating a tertiary care outreach diffi-
mental wellbeing needs of patients under spe- cult asthma clinic on the Isle of Wight, UK.114
cialist services with difficult asthma is likely to That involved an Asthma/ Allergy Specialist
become a pressing need within difficult asth- Physician, Asthma Specialist Nurse, and Al-
ma MDT’s. lergy Dietitian alongside access to Respirato-
ry Physiotherapist and Clinical Psychologist.
The Asthma Dietitian Within 18 months of being under that care
pathway, difficult asthma patients showed
Obesity is a common finding among patients significant reductions in maintenance OCS
with difficult asthma. For example, in the use and dosing requirement. In addition sig-
WATCH study the average BMI of patients nificant reductions in asthma healthcare uti-
was 31, while the prevalence of obesity was lisation were observed with respect to GP vis-
48%.22 The presence of obesity is associat- its, Emergency Department visits, Hospital
bed days and Intensive Care Unit bed days.
ed with worse asthma outcomes and greater None of the patients in that study received bi-
disease severity. 110 Weight loss strategies can ologic therapies during the study period. Inte-
grating such MDT approaches to link acute
improve asthma outcomes particularly when inpatient care and outpatient care can also
combined with other behavioural interven- deliver significant benefits for difficult asthma
tions targeting exercise and/ or mental well- patients.64 An MDT was implemented com-
being.111 The input of a dietitian to support prising Asthma Specialist Physician, Asth-
ma Specialist Nurse, Respiratory Physiother-
such interventions could be very impactful but apist and Clinical Psychologist spanned the
there is little evidence base in the literature on patient journey from inpatient to outpatient
which to guide that role. Another role of the care. Over the course of 2-years this interven-
dietitian may be in those asthma patients who tion reduced repeated asthma admissions by
have significant food allergies. The combina- 33%, associated bed-days by 52% and associ-
tion of food allergy and asthma is mutually ated repeat admission costs by 35%.
detrimental and the role of a skilled dietitian
to establish safe food practices is invaluable in
that setting.112 The role of dietitians in allergy
practice is well-established and may provide
trol and anxiety levels, though wider effects pathways in difficult asthma.113
severe asthma forum 1: severe asthma - basic and clinical views could not be discerned. Additionally incon-
sistent study methodology reduced the degree Impact of Combined Difficult Asthma
to which these results could be interpreted.108 MDT Approaches
A case series from UK difficult asthma cen-
tres illustrated the potential individual patient The multimorbid nature of difficult asthma
benefits that can be obtained using CBT in- ideally requires an integrated MDT approach
terventions.109 to properly address the constituent parts. Sig-
nificant benefits from such an approach have
A potential role for the Asthma Psy- recently been demonstrated utilising a struc-
chologist within a multidimensional interven- tured assessment to identify treatable traits,
tion is indicated by the recent demonstration aligned with appropriate MDT involvement
of a clustering of extrapulmonary comorbidi- that was coordinated by a nurse case manag-
ties in difficult asthma patients with very poor er.28 These included improvements in quality
asthma control. These included psychological of life, asthma control and acute primary care
factors such as depression and anxiety plus asthma visits. Previously an integrated MDT
obesity and physical inactivity.24 Adequate approach was established by our Institution
Psychologist resource and time to support the when initiating a tertiary care outreach diffi-
mental wellbeing needs of patients under spe- cult asthma clinic on the Isle of Wight, UK.114
cialist services with difficult asthma is likely to That involved an Asthma/ Allergy Specialist
become a pressing need within difficult asth- Physician, Asthma Specialist Nurse, and Al-
ma MDT’s. lergy Dietitian alongside access to Respirato-
ry Physiotherapist and Clinical Psychologist.
The Asthma Dietitian Within 18 months of being under that care
pathway, difficult asthma patients showed
Obesity is a common finding among patients significant reductions in maintenance OCS
with difficult asthma. For example, in the use and dosing requirement. In addition sig-
WATCH study the average BMI of patients nificant reductions in asthma healthcare uti-
was 31, while the prevalence of obesity was lisation were observed with respect to GP vis-
48%.22 The presence of obesity is associat- its, Emergency Department visits, Hospital
bed days and Intensive Care Unit bed days.
ed with worse asthma outcomes and greater None of the patients in that study received bi-
disease severity. 110 Weight loss strategies can ologic therapies during the study period. Inte-
grating such MDT approaches to link acute
improve asthma outcomes particularly when inpatient care and outpatient care can also
combined with other behavioural interven- deliver significant benefits for difficult asthma
tions targeting exercise and/ or mental well- patients.64 An MDT was implemented com-
being.111 The input of a dietitian to support prising Asthma Specialist Physician, Asth-
ma Specialist Nurse, Respiratory Physiother-
such interventions could be very impactful but apist and Clinical Psychologist spanned the
there is little evidence base in the literature on patient journey from inpatient to outpatient
which to guide that role. Another role of the care. Over the course of 2-years this interven-
dietitian may be in those asthma patients who tion reduced repeated asthma admissions by
have significant food allergies. The combina- 33%, associated bed-days by 52% and associ-
tion of food allergy and asthma is mutually ated repeat admission costs by 35%.
detrimental and the role of a skilled dietitian
to establish safe food practices is invaluable in
that setting.112 The role of dietitians in allergy
practice is well-established and may provide
