TY - JOUR

T1 - Systematic Assessment of Difficult-to-Treat Asthma

T2 - Principles and Perspectives

AU - Hew, Mark

AU - Menzies-Gow, Andrew

AU - Hull, James H.

AU - Fleming, Louise

AU - Porsbjerg, Celeste

AU - Brinke, Anneke Ten

AU - Allen, David

AU - Gore, Robin

AU - Tay, Tunn Ren

PY - 2020

Y1 - 2020

N2 - Difficult-to-treat asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.

AB - Difficult-to-treat asthma affects a minority of adults and children with asthma but represents a challenging mix of misdiagnosis, multimorbidity, inadequate self-management, severe airway pathobiology, and treatment complications. Management of these patients extends beyond asthma pharmacotherapy, because multiple other patient-related domains need to be addressed as well. Such complexity can hinder adequate clinical assessment even when performed in specialist practice. Systematic assessment undertaken by specialized multidisciplinary teams brings a broad range of resources to bear on patients with difficult-to-treat asthma. Although the concept of systematic assessment is not new, practices vary considerably and implementation is not universal. Nevertheless, assessment protocols are already in place in several institutions worldwide, and outcomes after such assessments have been highly encouraging. This review discusses the rationale, components, and benefits of systematic assessment, outlining its clinical utility and the available evidence for improved outcomes. It describes a range of service configurations and assessment approaches, drawing examples from severe asthma centers around the world to highlight common essential elements. It also provides a framework for establishing such services and discusses practical considerations for implementation.

KW - Adherence

KW - Comorbidities

KW - Diagnosis

KW - Difficult asthma

KW - Personalized medicine

KW - Protocolized

KW - Severe asthma

KW - Treatable traits

U2 - 10.1016/j.jaip.2020.02.036

DO - 10.1016/j.jaip.2020.02.036

M3 - Review

C2 - 32173508

AN - SCOPUS:85082523545

VL - 8

SP - 2222

EP - 2233

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

SN - 2213-2198

IS - 7

ER -