Overcoming Barriers to the Effective Management of Severe Asthma in Italy

Abstract

People with severe asthma (SA) often have poor disease control and quality of life, and are at high risk of exacerbations, lung function decline and asthma-related death. The present expert opinion article aimed to identify unmet needs in the management of SA in Italy, and propose possible solutions to address these needs. Methods: At five multidisciplinary events in Italy, attendees identified factors that interfered with the effective management of SA and suggested how these barriers could be overcome. A core group of 12 Italian experts (pulmonologists, general practitioners, allergists, payers and patients) identified the main issues and proposed possible solutions based on the results from the meetings and relevant articles from the literature. Results and Conclusions: We reviewed the gap between real-world practice and guidelines, oral corticosteroid overuse, SA-related mortality, and barriers to effective SA treatment. Common themes were lack of awareness about SA among both patients and clinicians, and lack of networking/information exchange between those involved in the treatment of SA. Participants agreed on the need to implement patient education and create multidisciplinary groups of specialists to improve SA management through multidisciplinary educational initiatives, meetings with local experts, development of a flow chart for referral/connection with local experts and specialized centers. Clinical instruments that might help specialists improve SA management included referral networks, integrated care pathways, phenotyping and treatment algorithms, exacerbation tracking, and examination of electronic medical records for patients with uncontrolled asthma. The following actions need to be implemented in Italy: i) maximize the use of advanced therapies, eg, biologics; ii) increase/improve education for physicians and patients; iii) improve multidisciplinary communication and care coordination; iv) introduce regional and local protocols for SA diagnosis and treatment; and v) change the structure of healthcare services to reduce specialist waiting times and facilitate access to biologic therapies.

Using a knowledge translation framework to identify health care professionals’ perceived barriers and enablers for personalised severe asthma care

“…With the emergence of biological therapies, the complexity of treatments for asthma patients has increased even more [ 26 ]. Interestingly a similar pattern of insights was obtained from people with severe asthma themselves wherein they reported lack of awareness and self-management and poor treatment adherence as barriers to correct and timely diagnosis of severe asthma [ 37 ]. This highlights the importance of understanding the drivers of patient behaviour change [ 35 ] including trade-off preferences [ 38 ] for developing effective personalised strategies to promote medication adherence in severe asthma [ 35 ].…”

Patients With Severe Asthma Need Accurate Diagnosis and Correct Treatment: How Can We Achieve That?

“…2,14 This observed trend may be due to the physical distancing and increased hygiene measures imposed worldwide. Additionally, an increase in the fear of acquiring COVID-19 measured among patients with asthma 14,15 might have led to a decrease or delay in healthcare visits. Innovative approaches using tools, such as teleconsultation and digital medicine services, are strongly encouraged to ensure sustained follow-up and good communication with patients especially when selfadministration of treatment is done.…”