Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings

Steven Maltby^{1

2

3}, Vanessa M McDonald^{1

2

3

4}, John W Upham^{1

5}, Simon D Bowler⁶, Li P Chung⁷, Eve J Denton⁸, James Fingleton⁹, Jeffrey Garrett¹⁰, Christopher L Grainge^{2

3

4}, Mark Hew⁸, Alan L James^{1

11

12}, Christine Jenkins^{13

14

15}, Gregory Katsoulotos¹⁶, Gregory G King^{1

17}, David Langton^{18

19}, Guy B Marks^{1

17

20}, Andrew Menzies-Gow²¹, Robert M Niven²², Matthew Peters²³, Helen K Reddel^{1

17}, Francis Thien^{1

24}, Paul S Thomas²⁵, Peter A B Wark^{1

2

3

4}, Elaine Yap¹⁰, Peter G Gibson^{1

2

3

4}; Severe Asthma Expert Forum contributors

Affiliations

¹ National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.
² Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.
³ Hunter Medical Research Institute, Newcastle, Australia.
⁴ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
⁵ Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁶ Immunity, Infection, and Inflammation Program, Mater Medical Research Institute, South Brisbane, Queensland, Australia.
⁷ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
⁸ Department of Respiratory Medicine, The Alfred Hospital and Austin Health, Melbourne, Victoria, Australia.
⁹ Capital and Coast District Health Board and Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁰ Middlemore Hospital, Auckland, New Zealand.
¹¹ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
¹² Australia and School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia.
¹³ Department of Thoracic Medicine, Concord Hospital, Concord Clinical School and Respiratory Discipline, University of Sydney, Concord, New South Wales, Australia.
¹⁴ The George Institute for Global Health, Newtown, New South Wales, Australia.
¹⁵ UNSW, Sydney, Liverpool, New South Wales, Australia.
¹⁶ St George Specialist Centre, Kogarah, New South Wales, Australia.
¹⁷ Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
¹⁹ Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia.
²⁰ South Western Sydney Clinical School, UNSW, Australia.
²¹ Respiratory Medicine, Royal Brompton Hospital, London, UK.
²² Division of Infection, Immunity & Respiratory Medicine, Manchester Academic Health Science Centre and North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
²³ Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia.
²⁴ Department of Respiratory Medicine, Eastern Health and Monash University, Box Hill, Victoria, Australia.
²⁵ Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

PMID: 32104958
DOI: 10.1111/imj.14806

Review

Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings

Steven Maltby et al. Intern Med J. 2021 Feb.

. 2021 Feb;51(2):169-180.

doi: 10.1111/imj.14806.

Authors

Affiliations

¹ National Health and Medical Research Council Centre of Excellence in Severe Asthma, Newcastle, Australia.
² Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.
³ Hunter Medical Research Institute, Newcastle, Australia.
⁴ Department of Respiratory and Sleep Medicine, John Hunter Hospital, Newcastle, Australia.
⁵ Department of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia.
⁶ Immunity, Infection, and Inflammation Program, Mater Medical Research Institute, South Brisbane, Queensland, Australia.
⁷ Department of Respiratory Medicine, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
⁸ Department of Respiratory Medicine, The Alfred Hospital and Austin Health, Melbourne, Victoria, Australia.
⁹ Capital and Coast District Health Board and Medical Research Institute of New Zealand, Wellington, New Zealand.
¹⁰ Middlemore Hospital, Auckland, New Zealand.
¹¹ Department of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
¹² Australia and School of Medicine and Pharmacology, University of Western Australia, Western Australia, Australia.
¹³ Department of Thoracic Medicine, Concord Hospital, Concord Clinical School and Respiratory Discipline, University of Sydney, Concord, New South Wales, Australia.
¹⁴ The George Institute for Global Health, Newtown, New South Wales, Australia.
¹⁵ UNSW, Sydney, Liverpool, New South Wales, Australia.
¹⁶ St George Specialist Centre, Kogarah, New South Wales, Australia.
¹⁷ Woolcock Institute of Medical Research, University of Sydney, Sydney, New South Wales, Australia.
¹⁸ Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, Victoria, Australia.
¹⁹ Department of Thoracic Medicine, Frankston Hospital, Frankston, Victoria, Australia.
²⁰ South Western Sydney Clinical School, UNSW, Australia.
²¹ Respiratory Medicine, Royal Brompton Hospital, London, UK.
²² Division of Infection, Immunity & Respiratory Medicine, Manchester Academic Health Science Centre and North West Lung Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK.
²³ Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia.
²⁴ Department of Respiratory Medicine, Eastern Health and Monash University, Box Hill, Victoria, Australia.
²⁵ Faculty of Medicine, University of New South Wales, Sydney, New South Wales, Australia.

PMID: 32104958
DOI: 10.1111/imj.14806

Abstract

Severe asthma imposes a significant burden on individuals, families and the healthcare system. Treatment is complex, due to disease heterogeneity, comorbidities and complexity in care pathways. New approaches and treatments improve health outcomes for people with severe asthma. However, emerging multidimensional and targeted treatment strategies require a reorganisation of asthma care. Consensus is required on how reorganisation should occur and what areas require further research. The Centre of Excellence in Severe Asthma convened three forums between 2015 and 2018, hosting experts from Australia, New Zealand and the UK. The forums were complemented by a survey of clinicians involved in the management of people with severe asthma. We sought to: (i) identify areas of consensus among experts; (ii) define activities and resources required for the implementation of findings into practice; and (iii) identify specific priority areas for future research. Discussions identified areas of unmet need including assessment and diagnosis of severe asthma, models of care and treatment pathways, add-on treatment approaches and patient perspectives. We recommend development of education and training activities, clinical resources and standards of care documents, increased stakeholder engagement and public awareness campaigns and improved access to infrastructure and funding. Further, we propose specific future research to inform clinical decision-making and develop novel therapies. A concerted effort is required from all stakeholders (including patients, healthcare professionals and organisations and government) to integrate new evidence-based practices into clinical care and to advance research to resolve questions relevant to improving outcomes for people with severe asthma.

Keywords: asthma; comorbidity; multidimensional assessment; quality of life; targeted therapy.

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References

1. Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343-73.
1. von Bulow A, Kriegbaum M, Backer V, Porsbjerg C. The prevalence of severe asthma and low asthma control among Danish adults. J Allergy Clin Immunol Pract 2014; 2: 759-67.
1. Nordon C, Grimaldi-Bensouda L, Pribil C, Nachbaur G, Amzal B, Thabut G et al. Clinical and economic burden of severe asthma: a French cohort study. Respir Med 2018; 144: 42-9.
1. Lefebvre P, Duh MS, Lafeuille MH, Gozalo L, Desai U, Robitaille MN et al. Acute and chronic systemic corticosteroid-related complications in patients with severe asthma. J Allergy Clin Immunol 2015; 136: 1488-95.
1. Volmer T, Effenberger T, Trautner C, Buhl R. Consequences of long-term oral corticosteroid therapy and its side-effects in severe asthma in adults: a focused review of the impact data in the literature. Eur Respir J 2018; 52: 1800703.

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Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings

Affiliations

Severe asthma assessment, management and the organisation of care in Australia and New Zealand: expert forum roundtable meetings

Authors

Affiliations

Abstract

References

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MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

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Medical