Abstract
Patients with difficult-to-manage asthma represent a heterogeneous subgroup of asthma patients who require extensive assessment and tailored management. The International Primary Care Respiratory Group approach emphasises the importance of differentiating patients with asthma that is difficult to manage from those with severe disease. Local adaptation of this approach, however, is required to ensure an appropriate strategy for implementation in the Dutch context. We used a modified three-round e-Delphi approach to assess the opinion of all relevant stakeholders (general practitioners, pulmonologists, practice nurses, pulmonary nurses and people with asthma). In the first round, the participants were asked to provide potentially relevant items for a difficult-to-manage asthma programme, which resulted in 67 items. In the second round, we asked participants to rate the relevance of specific items on a seven-point Likert scale, and 46 items were selected as relevant. In the third round, the selected items were categorised and items were ranked within the categories according to relevance. Finally, we created the alphabet acronym for the categories ‘the A–I of difficult-to-manage asthma’ to resonate with an established Dutch ‘A–E acronym for determining asthma control’. This should facilitate implementation of this programme within the existing structure of educational material on asthma and chronic obstructive pulmonary disease (COPD) in primary care, with potential for improving management of difficult-to-manage asthma. Other countries could use a similar approach to create a locally adapted version of such a programme.
Highlights
Asthma is a common respiratory condition, accounting for serious morbidity for patients and an important negative impact on society and economy owing to high costs of medication, hospitalisation and loss of productivity.[1,2,3] Even 60% of the asthmatics are poorly controlled, which is related to a significant reduction in quality of life.[4,5]Mortality remains high despite the availability of effective therapies.[6]
Subgroup analyses The results of the subgroup analyses comparing responses of patients and professionals and between primary care and hospital care are given in an online supplement (Supplementary Tables 5a npj Primary Care Respiratory Medicine (2017) 16086
Our results show that both among patients and workshop on the ‘Adembenemend’ (‘Breath-taking’) course, which professionals, there is considerable emphasis on patient-specific is a 2-day course on the management of asthma and chronic obstructive pulmonary disease (COPD) in and behavioural issues, suggesting that these were seen as primary care for care teams consisting of general practitioners (GPs) and their practice nurses (PNs)
Summary
Asthma is a common respiratory condition, accounting for serious morbidity for patients and an important negative impact on society and economy owing to high costs of medication, hospitalisation and loss of productivity.[1,2,3] Even 60% of the asthmatics are poorly controlled, which is related to a significant reduction in quality of life.[4,5]Mortality remains high despite the availability of effective therapies.[6]. It is of vital importance to differentiate between patients with truly severe asthma (estimated as 3.6% of people with asthma in the Netherlands) from persons with difficult-to-manage asthma (estimated as 17.4% of people with asthma).[8] Difficult-to-manage asthma is asthma that either the person affected or the clinician finds difficult to manage, which may or may not be driven by the severity of the disease.[9] It requires identification and management of treatable traits,[10] predominantly beyond pharmacotherapy.[11] By doing so, the potentially life-saving but far very costly new types of treatment can be reserved for the patients with truly severe asthma.[12,13] International guidelines define severe asthma as asthma that requires treatment with high-dose inhaled corticosteroids plus a second controller and/or systemic corticosteroids to prevent it from becoming ‘uncontrolled’, or that remains ‘uncontrolled’ despite this therapy, when supervised by a specialised multidisciplinary team for at least 3 months.[4,14,15]. Further insight into the potential consequences of a diagnosis of severe asthma (such as the use of biologicals, revalidation-therapy, high-altitude treatment.) Diagnosis
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