The multidisciplinary team severe asthma day case assessment and its impact on patient care

Holmes, Leanne-Jo; Sheehan, Reyenna; Elsey, Lynn; Allen, David J.

doi:10.12968/hmed.2021.0142

Cited by 6 publications

(5 citation statements)

References 12 publications

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“…Although the importance of obesity, psychological status, and lifestyle has been highlighted, these factors are challenging to incorporate into regular monitoring because they require specialist input. In this regard, multidisciplinary teams may offer improved asthma management, although limited to tertiary care centers . Importantly, quality of life is not being adequately addressed, despite being prioritized as an outcome by patients, their families, and clinicians .…”

Section: Discussionmentioning

confidence: 99%

“…In this regard, multidisciplinary teams may offer improved asthma management, although limited to tertiary care centers. 42 Importantly, quality of life is not being adequately addressed, despite being prioritized as an outcome by patients, their families, and clinicians. 43 Environmental exposures are highly relevant to asthma activity in children, 44 , 45 but they also appear to be somehow neglected, possibly because of the challenge of identifying the environmental triggers and their fluctuations and the difficulty of modifying them.…”

Section: Discussionmentioning

confidence: 99%

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Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

et al. 2023

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ImportanceChildhood asthma control largely depends on rigorous and regular monitoring. Although various clinical parameters, biomarkers, and patient-reported outcomes are helpful for monitoring purposes, there is no consensus on the minimum and/or optimal set of parameters and their relative priority.ObjectiveTo assess actual and perceived optimal childhood asthma monitoring practices used globally.Design, Setting, and ParticipantsThis international, multistakeholder survey study surveyed health care professionals and clinical academics with a professional interest in and exposure to childhood asthma between April 12 and September 3, 2021, to test for differences between the frequency that different techniques are actually used in practice vs optimal practice, between-group differences, and differences across medical settings and country economies.Main Outcomes and MeasuresOutcomes were frequency of duration of asthma monitoring visits as well as actual and perceived optimal use and importance of monitoring tools and domains.ResultsA total of 1319 participants with expertise in childhood asthma from 88 countries completed the survey. Participants included 1228 health care professionals with a balanced distribution across different care settings (305 [22.7%] primary care, 401 [29.9%] secondary, and 522 [38.9%] tertiary care) and 91 researchers. Children with mild to moderate asthma attended regular monitoring visits at a median (IQR) of 5.0 (2.5-8.0) months, with visits lasting a median (IQR) of 25 (15-25) minutes, whereas severe asthma required more frequent visits (median [IQR], 2.5 [1.0-2.5] months; median [IQR] duration, 25 [25-35] minutes). Monitoring of symptoms and control, adherence, comorbidities, lung function, medication adverse effects, and allergy were considered to be very high or high priority by more than 75% of the respondents. Different patterns emerged when assessing differences between actual and perceived optimal use of monitoring tools. For some tools, current and optimal practices did not differ much (eg, spirometry), whereas in others, there was considerable space for improvement (eg, standardized control and adherence tests). The largest gap was observed for between-visit monitoring with electronic trackers, apps, and smart devices. Differences across country economies, care settings, and medical specialties were modest.Conclusions and RelevanceThese survey results suggest that pediatric asthma monitoring is performed generally homogeneously worldwide, in most cases following evidence-based standards. Wider use of standardized instruments and the intensification of continuous between-visit monitoring, supported by electronic devices, is needed for further improvement of disease outcomes. The results of this survey, in conjunction with the available evidence base, can inform recommendations toward further optimization.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

et al. 2023

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“…Outcome measures may include questionnaires to understand patient-reported symptoms and aid evaluation of breathlessness [ 19 ] as shown in table 2 . Assessment of the patient includes observation of breathlessness and breathing pattern, hands-on assessment including Manual Assessment of Respiratory Motion, and may include lung function testing [ 46 , 47 ]. Alternatively, a validated measure such as the Breathing Pattern Assessment Tool can be used to score aspects of breathing pattern [ 35 ].…”

Section: Mdt Rolesmentioning

confidence: 99%

Multidisciplinary management of inducible laryngeal obstruction and breathing pattern disorder

Ludlow,

Daly,

Elsey

et al. 2023

Breathe

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We provide an overview of the assessment and management of inducible laryngeal obstruction and breathing pattern disorder. We highlight the multidisciplinary team members involved and their essential roles within a complex breathlessness service. We discuss treatments initiated by physiotherapy and speech and language therapy, the importance of joint working, and discuss the high incidence of comorbidities and the association with other respiratory disorders.Educational aimsInducible laryngeal obstruction and breathing pattern disorder are common causes of breathlessness.Inducible laryngeal obstruction is an inappropriate, transient, reversible narrowing of the laryngeal area that causes breathlessness and laryngeal symptoms.Breathing pattern disorder is an alteration in the normal biomechanical patterns of breathing that results in intermittent or chronic symptoms, which may be respiratory and/or non-respiratory.People with inducible laryngeal obstruction or breathing pattern disorder often have other comorbidities that will also need addressing.Multidisciplinary assessment and treatment is essential for comprehensive workup and holistic care.Timely assessment and diagnosis can prevent unnecessary medication use and hospital admissions and facilitate effective management of the condition using reassurance, advice, education, breathing retraining and vocal exercises.

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“…Collaboration between different specialities ensures that thorough patient-centred assessment is coupled with clinical expertise. 11 When assessing patients with DTT asthma, other specialities (e.g. ear, nose and throat [ENT] surgeon and speech pathologist) are ideally required to help distinguish upper from lower airway causes of symptoms as the mechanisms of the upper and lower airways are complex and often misunderstood.…”

Section: Meeting Unmet Needs: the Uac Is Createdmentioning

confidence: 99%

“…Reflecting on the asthmatic population within the practice, it was felt that there was a real need for improved patient outcomes evaluating current evidence including multidimensional assessment, improved diagnosis and effective communication between all key stakeholders. Collaboration between different specialities ensures that thorough patient‐centred assessment is coupled with clinical expertise 11 . When assessing patients with DTT asthma, other specialities (e.g.…”

Section: Meeting Unmet Needs: the Uac Is Createdmentioning

confidence: 99%

The United Airways Clinic: roadmap of a patient‐centred multidisciplinary approach to the complex airways patient: the Sydney model

Macfie,

Raftopulos,

Eastwood

et al. 2023

Internal Medicine Journal

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Severe asthma is a subset of difficult‐to‐treat asthma which requires a systematic and multidimensional approach including the need to manage multiple comorbidities that mimic asthma. Multidisciplinary care is becoming the standard for the assessment of such patients. Multidisciplinary team (MDT) clinics are virtually nonexistent in the private space. We developed an MDT clinic to handle needs in the private space and found it was an invaluable tool for assessment, reflective practice and professional development.

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The multidisciplinary team severe asthma day case assessment and its impact on patient care

Cited by 6 publications

References 12 publications

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

Current and Optimal Practices in Childhood Asthma Monitoring Among Multiple International Stakeholders

Multidisciplinary management of inducible laryngeal obstruction and breathing pattern disorder

The United Airways Clinic: roadmap of a patient‐centred multidisciplinary approach to the complex airways patient: the Sydney model

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