Dataset Information

Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey.

ABSTRACT: The Working Group on Severe Asthma of the Korean Academy of Allergy and Clinical Immunology recently published an expert opinion paper on the management of severe asthma in Korea. When developing a consensus, the working group encountered several diagnostic and treatment issues and decided to perform a questionnaire survey of Korean specialists with regard to severe asthma. An e-mail with a uniform resource locator link to the questionnaire was sent to 121 asthma specialists, of whom 44.6% responded. The most commonly accepted definitions of severe asthma were a history of fatal exacerbation or an asthma-triggered need for mechanical ventilation, 3-4 oral corticosteroid (OCS) bursts/year, and maintenance of OCS therapy for 3-6 months per year. Before diagnosing severe asthma, most physicians contemplate chest computed tomography, seek to control chronic rhinosinusitis, and consider poor inhaler compliance. For patients with uncontrolled severe asthma accompanied by type 2 (T2)-high inflammation, most biologics available in Korea were considered appropriate, but gaps were apparent in terms of T2-low asthma treatments. These findings about specialist perception of diagnosis and treatment of severe asthma will inform the use of emerging new drugs and facilitate personalized therapy.

SUBMITTER: Kim MA

PROVIDER: S-EPMC7984944 | biostudies-literature | 2021 May

REPOSITORIES: biostudies-literature

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Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey.

Kim Mi Ae MA Park Heung Woo HW Kim Byung Keun BK Park So Young SY Ban Ga Young GY Lee Ji Hyang JH An Jin J Shim Ji Su JS Lee Youngsoo Y Won Ha Kyeong HK Lee Hwa Young HY Sohn Kyoung Hee KH Kang Sung Yoon SY Park So Young SY Lee Hyun H Kim Min Hye MH Kwon Jae Woo JW Yoon Sun Young SY Lee Jae Hyun JH Rhee Chin Kook CK Moon Ji Yong JY Lee Taehoon T Kim So Ri SR Park Jong Sook JS Kim Sang Heon SH Jeong Jae Won JW Kim Sang Hoon SH Koh Young Il YI Oh Yeon Mok YM Jang An Soo AS Yoo Kwang Ha KH Cho You Sook YS

Allergy, asthma & immunology research 20210501 3

The Working Group on Severe Asthma of the Korean Academy of Allergy and Clinical Immunology recently published an expert opinion paper on the management of severe asthma in Korea. When developing a consensus, the working group encountered several diagnostic and treatment issues and decided to perform a questionnaire survey of Korean specialists with regard to severe asthma. An e-mail with a uniform resource locator link to the questionnaire was sent to 121 asthma specialists, of whom 44.6% respo ...[more]

PMID: 33733643

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Project description:PURPOSE:Severe asthma and asthma-chronic obstructive pulmonary disease (COPD) overlap syndrome (ACOS) are difficult to control and are often associated with poor clinical outcomes. However, much is not understood regarding the diagnosis and treatment of severe asthma and ACOS. To evaluate the current perceptions of severe asthma and COPD among asthma and COPD specialists, we designed an e-mail and internet-based questionnaire survey. METHODS:Subjects were selected based on clinical specialty from among the members of the Korean Academy of Asthma, Allergy and Clinical Immunology and the Korean Academy of Tuberculosis and Respiratory Diseases. Of 432 subjects who received an e-mail invitation to the survey, 95 subjects, including 58 allergists and 37 pulmonologists, responded and submitted their answers online. RESULTS:The specialists estimated that the percentage of severe cases among total asthma patients in their practice was 13.9%±11.0%. Asthma aggravation by stepping down treatment was the most common subtype, followed by frequent exacerbation, uncontrolled asthma despite higher treatment steps, and serious exacerbation. ACOS was estimated to account for 20.7% of asthma, 38.0% of severe asthma, and 30.1% of COPD cases. A history of smoking, persistently low forced expiratory volume in 1 second (FEV1), and low FEV1 variation were most frequently classified as the major criteria for the diagnosis of ACOS among asthma patients. Among COPD patients, the highly selected major criteria for ACOS were high FEV1 variation, positive bronchodilator response, a personal history of allergies and positive airway hyperresponsiveness. Allergists and pulmonologists showed different assessments and opinions on asthma phenotyping, percentage, and diagnostic criteria for ACOS. CONCLUSIONS:Specialists had diverse perceptions and clinical practices regarding severe asthma and ACOS patients. This heterogeneity must be considered in future studies and strategy development for severe asthma and ACOS.

Project description:IntroductionThe aim of our observational study was to understand how patients with uncontrolled severe asthma perceive asthma control, and to assess their views on the role of healthcare professionals (HCPs) and other stakeholders in asthma management.MethodsIn total, 200 patients with uncontrolled, severe asthma living in Canada, France, Germany, Italy, Spain, the UK, or the USA registered on the Carenity asthma community responded to a patient survey.ResultsWhile 62% of respondents indicated they knew a lot about asthma, they were not entirely satisfied with its control. The two most helpful tools considered important in long-term asthma control were centered on learning, with tips on asthma control (76%), as well as information on asthma and its causes (67%). Although asthma education programs were accessible to less than half (44%) of the respondents, 72% said they would find them useful. In the previous year, most patients (78%) consulted a specialist; however, while 54% of respondents participated in shared decision-making (SDM) concerning their treatment, less than one-third (29%) felt their opinion had been considered, and only 27% said it helped their HCPs to develop an informed action plan. However, 48% believed that SDM would help them feel more confident in achieving long-term control. Most respondents consulted emergency room doctors or nurse practitioners because of their uncontrolled severe asthma, finding them persuasive sources of information. Additionally, patient advocacy organizations (PAGs) were considered as a preferred (12%) or persuasive (6%) source by only a few patients.ConclusionMost people with uncontrolled severe asthma were well informed about their disease. However, better information on asthma management would be useful for patients, with HCPs involved in this process. SDM was welcomed by respondents, but, to be successful, the patients' opinions should be taken into consideration when forming an asthma management action plan.

Project description:The Asthma Control Questionnaire (ACQ) is used to assess asthma symptom control. The relationship between the questionnaire items and symptom control has not been fully studied in severe asthmatic patients, and its validity for making comparisons between subgroups of patients is unknown. Data was obtained from patients in the United Kingdom Severe Asthma Registry whose symptom control was assessed using the five-item ACQ (ACQ5) (n = 2,951). Confirmatory factor analysis determined whether a latent factor for asthma symptom control, as measured by the ACQ5, was consistent with the data. Measurement invariance was examined in relation to ethnicity, sex and age; this included testing for approximate measurement invariance using Bayesian Structural Equation Modelling (BSEM). The fitted models were used to estimate the internal consistency reliability of the ACQ5. Invariance of factor means across subgroups was assessed. A one-factor construct with residual correlations for the ACQ5 was an excellent fit to the data in all subgroups (Root Mean Square Error Approximation 0.03 [90%CI 0.02,0.05], p-close fit 0.93, Comparative Fit Index 1.00, Tucker Lewis Index 1.00}. Expected item responses were consistent for Caucasian and non-Caucasian patients with the same absolute level of symptom control. There was some evidence that females and younger adults reported wakening more frequently during the night than males and older adults respectively with the same absolute level of symptom control (p<0.001). However approximate measurement invariance was tenable and any failure to observe strong measurement invariance had minimal impact when comparing mean levels of asthma symptom control between patients of different sexes or ages. Average levels of asthma symptom control were lower for non-Caucasians (p = 0.001), females (p<0.01)and increased with age (p<0.01). Reliability of the instrument was high (over 88%) in all subgroups studied. The ACQ5 is informative in comparing levels of symptom control between severe asthmatic patients of different ethnicities, sexes and ages. It is important that analyses are replicated in other severe asthma registries to determine whether measurement invariance is observed.

Project description:Severe asthma in children carries an unacceptable treatment burden, yet its rarity means clinical experience in treating it is limited, even among specialists. Practical guidance is needed to support clinical decision-making to optimize treatment for children with this condition.This modified Delphi convened 16 paediatric pulmonologists and allergologists from northern Europe, all experienced in treating children with severe asthma. Informed by interviews with stakeholders involved in the care of children with severe asthma (including paediatricians, nurses and carers), and an analysis of European guidelines, the experts built a consensus focused on the gaps in existing guidance. Explored were considerations for optimizing care for patients needing biologic treatment, and for selecting home or hospital delivery of biologics. This consensus is aimed at clinicians in specialist centres, as well as general paediatricians, paediatric allergologists and paediatric pulmonologists who refer children with the most severe asthma to specialist care. Consensus is based on expert opinion and is intended for use alongside published guidelines.Our discussions revealed three key facets to optimizing care. Firstly, early asthma detection in children presenting with wheezing and/or dyspnoea is vital, with a low threshold for referral from primary to specialist care. Secondly, children who may need biologics should be referred to and managed by specialist paediatric asthma centres; we define principles for the specialist team members, tests, and expertise necessary at such centres, as well as guidance on when homecare biologics delivery is and is not appropriate. Thirdly, shared decision-making is essential at all stages of the patient's journey: clear, concise treatment plans are vital for patient/carer self-management, and structured processes for transition from paediatric to adult services are valuable. The experts identified the potential for specialist paediatric asthma nurses to play a significant role in facilitating multidisciplinary working.Through this project is agreed a framework of practical advice to optimize the care of children with severe asthma. We encourage clinicians and policymakers to implement this practical advice to enhance patient care.

Dataset Information

Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey.

Publications

Specialist Perception of Severe Asthma in Korea: A Questionnaire Survey.

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