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. 2021 Jun 29;16(6):e0253468.
doi: 10.1371/journal.pone.0253468. eCollection 2021.

Attitudes of Croatian pulmonologists concerning obstacles to earlier, more appropriate use of biologics in severe asthma: Survey results

Sanja Popović Grle  1   2 , Marina Lampalo  1 , Sanda Škrinjarić Cincar  3   4 , Ljiljana Bulat Kardum  5   6 , Ivan Gudelj  7   8 , Eugenija Basioli Kasap  9 , Mirna Vergles  2   10 , Neven Tudorić  2   10
Affiliations

Attitudes of Croatian pulmonologists concerning obstacles to earlier, more appropriate use of biologics in severe asthma: Survey results

Sanja Popović Grle et al. PLoS One. .

Abstract

Aims: Biologics have been proven efficacious for patients with severe asthma (SA). It is essential to diagnose such individuals correctly. This study was designed to survey pulmonologists to identify barriers to early diagnosis and subsequent appropriate use of biologics for SA in Croatia.

Methods: A pulmonologist group with expertise in SA developed the initial list of questions, with the final questionnaire created according to a 2-round Delphi method. The resulting survey consisted of 23 items consequently divided into 4 domains: 1) Pulmonologists' demographics and professional experiences; 2) Concerns about asthma management; 3) Attitudes toward SA diagnosis; and 4) Beliefs and attitudes regarding the use of biologics in managing SA. The given answers represented the respondents' estimates.

Results: Eighty-four surveys were analyzed, with pulmonologists observing that general practitioners often inaccurately diagnose asthma and treat acute exacerbations. Although specialist centers are capably and correctly equipped, the time to diagnose patients with SA is approximately 3.5 months, with initial use of biologics delayed an additional 2 months. The primary indications for prescribing biologics are conventional therapy with oral glucocorticoids (91.7%) and frequent acute exacerbations (82.1%). In addition to improper diagnosis (64.3%), many patients with SA do not receive the indicated biologics owing to strict administrative directives for reimbursement (70.2%) or limited hospital resources (57.1%).

Limitations: The limitations of this survey include the subjective nature of the collected data, the relatively small sample size, and the lack of the biologic efficacy evaluation.

Conclusions: Croatian pulmonologists observed that a significant number of patients with SA who are eligible for biologics are not prescribed them, largely because of an inaccurate and/or delayed diagnosis, a delayed referral to a specialist center, highly restrictive criteria for reimbursement, and/or institutional budgetary limitations.

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Conflict of interest statement

The project was funded by AstraZeneca for logistical and medical writing support. SPG has received compensation for advisory board membership from AstraZeneca, Boehringer Ingelheim, Novartis, Pliva-Teva, GlaxoSmithKline, Berlin-Chemie, Sanofi, Providens, Pharmas, and Medis; has received a grant from Novartis; and has received fees for lectures at symposia organized by AstraZeneca, Boehringer Ingelheim, Novartis, Pliva-Teva, GlaxoSmithKline, Berlin-Chemie, Sanofi, MSD, Pfizer, UCB Pharma, Providens, Pharmas, and Medis. ML received lecturing/consulting fees from Pliva/Teva and lecturing fees from Providens, AstraZeneca, Sandoz, Novartis, Berlin-Chemie, and GlaxoSmithKline. SSC received fees from Boehringer Ingelheim, Providens, Novartis, GlaxoSmithKline, AstraZeneca, Alkaloid, Salvus, Medis, Teva-Pliva, Roche, and Sanofi Genzyme. LBK received lecturing/consultancy fees from AstraZeneca, Boehringer Ingelheim, Roche, Pliva, Sanofi Aventis, and Novartis; lecturing fees from Sandoz, Providens, Berlin-Chemie, Abbott, Oktal Pharma, and Salvus; and received consultancy fees from GlaxoSmithKline. IG received consultancy fees from Boehringer Ingelheim, AstraZeneca, and Novartis; and lecturing fees from MSD, Teva, and Sandoz. EBK received lecturing/consulting fees from Boehringer Ingelheim, AstraZeneca, Chiesi, GlaxoSmithKline, Abbott, and Sandoz. MV received lecturing fees from GlaxoSmithKline, Pliva, Providens, AstraZeneca, Salveo, Alkaloid, and Boehringer Ingelheim. NT received lecturing/consulting fees from Boehringer Ingelheim, AstraZeneca, Berlin-Chemie Menarini, Chiesi, GlaxoSmithKline, Meda, Novartis, and Sandoz. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Flow of the participants through the study.
Fig 2
Fig 2. The regional distribution of surveyed pulmonologists.
Distribution is shown in relationship to administrative regional division of Croatia into four regions: Northern and Middle, Western, Eastern, and Southern, including data about population, and number of pulmonologists and residents [14, 15]. This also corresponds with location of referral centers for severe asthma in Croatia (two centers in Zagreb, one at Split, Rijeka, Zadar, and Osijek). Reprinted with permission from Kay Square Press, Inc.
See this image and copyright information in PMC

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