Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Vibeke Backer¹, Lars Olaf Cardell^{2

3}, Lauri Lehtimäki^{4

5}, Sanna Toppila-Salmi⁶, Leif Bjermer⁷, Sietze Reitsma⁸, Peter W Hellings^{8

9

10}, Dan Weinfeld¹¹, Kasper Aanæs¹, Charlotte Suppli Ulrik^{12

13}, Gert-Jan Braunstahl^{14

15}, Bernt Bøgvald Aarli^{16

17}, Arild Danielsen¹⁸, Hannu Kankaanranta^{5

19

20}, Sverre Steinsvåg²¹, Claus Bachert^{2

10

22}

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
² Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
³ Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
⁴ Allergy Centre, Tampere University Hospital, Tampere, Finland.
⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁶ Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁷ Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
⁸ Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.
⁹ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
¹⁰ Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.
¹¹ Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden.
¹² Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
¹³ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁴ Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
¹⁵ Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands.
¹⁶ Department of Clinical Science, University of Bergen, Bergen, Norway.
¹⁷ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
¹⁸ Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway.
¹⁹ Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
²⁰ Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway.
²² Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

PMID: 36895864
PMCID: PMC9989256
DOI: 10.3389/falgy.2023.1052386

Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Vibeke Backer et al. Front Allergy. 2023.

. 2023 Feb 21:4:1052386.

doi: 10.3389/falgy.2023.1052386. eCollection 2023.

Authors

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
² Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
³ Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
⁴ Allergy Centre, Tampere University Hospital, Tampere, Finland.
⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁶ Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁷ Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
⁸ Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.
⁹ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
¹⁰ Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.
¹¹ Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden.
¹² Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
¹³ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁴ Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
¹⁵ Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands.
¹⁶ Department of Clinical Science, University of Bergen, Bergen, Norway.
¹⁷ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
¹⁸ Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway.
¹⁹ Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
²⁰ Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway.
²² Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

PMID: 36895864
PMCID: PMC9989256
DOI: 10.3389/falgy.2023.1052386

Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines.

Methods: Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions.

Results: Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified.

Conclusion: This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.

Keywords: asthma; chronic rhinosinusitis with nasal polyps (CRSwNP); global airways disease; interdisciplinary care; nasal polyps; respiratory hypersensitivity; rhinitis; sinusitis.

PubMed Disclaimer

Conflict of interest statement

LOC has received institutional grants and/or personal fees from Orion Pharma, Sanofi, GlaxoSmithKline and ALK-Abello. LL has received honoraria for educational activities, lectures or advisory boards from ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundipharma, Novartis, Orion, Sanofi, and Teva. ST-S has received personal fees from ALK-Abello, Mylan Laboratories, Biomedical Systems, Roche Products, Sanofi Pharma, and Novartis Investments for consultancy, and a grant from GlaxoSmithKline. LB has during the last 3 years received honoraria for educational activities, lectures, or advisory boards from ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis, Sanofi, and Teva. SR has received honoraria for educational activities, lectures, advisory boards, and research grants from Novartis, Sanofi, and GlaxoSmithKline. DW has received renumeration for advisory boards with Teva and AstraZeneca. KA has received honoraria for educational activities and advisory boards from Sanofi. CU has received honoraria for educational activities, lectures, and advisory boards from AstraZeneca, GlaxoSmithKline, Sanofi, Mundipharma, Teva, Boehringer Ingelheim, Novartis, Orion Pharma, Actelion, ALK-Abello, and Sandoz. BA has received honoraria for educational activities and advisory boards from GlaxoSmithKline, AstraZeneca, Novartis, Sanofi-Aventis, Boehringer Ingelheim, and Chiesi outside the submitted work. HK has received personal fees and non-financial support from AstraZeneca, personal fees from Chiesi Pharma AB, personal fees from Boehringer Ingelheim, personal fees from MSD, personal fees from Novartis, personal fees and non-financial support from Orion Pharma, personal fees from Sanofi Genzyme, and personal fees from GlaxoSmithKline, outside the submitted work. CB has received honoraria as principal investigator of the study, consultant and advisory from Sanofi and Novartis, advisory boards from GlaxoSmithKline and as principal investigator from AstraZeneca. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

**Figure 1**
Schematic of the Appreciative Inquiry process used for this project.

**Figure 2**
Key differentiating symptoms of combined severe asthma and chronic rhinosinusitis with nasal polyps. Additional symptoms associated with other airways conditions may also be present including for allergic rhinitis: runny nose, itchy nose, eyes and ears, sneezy, nasal discharge, seasonal variation; for chronic rhinosinusitis: loss of smell, nasal closure/obstruction, facial headache, nasal discharge; and additionally for asthma: chest tightness, night time symptoms, exercise-induced symptoms.

See this image and copyright information in PMC

References

1. Soriano JB, Kendrick PJ, Paulson KR, Gupta V, Abrams EM, Adedoyin RA, et al. Prevalence and attributable health burden of chronic respiratory diseases, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet Respir Med. (2020) 8(6):585–96. 10.1016/S2213-2600(20)30105-3 - DOI - PMC - PubMed
1. Chen S, Zhou A, Emmanuel B, Thomas K, Guiang H. Systematic literature review of the epidemiology and clinical burden of chronic rhinosinusitis with nasal polyposis. Curr Med Res Opin. (2020) 36(11):1897–911. 10.1080/03007995.2020.1815682 - DOI - PubMed
1. Lourijsen ES, Fokkens WJ, Reitsma S. Direct and indirect costs of adult patients with chronic rhinosinusitis with nasal polyps. Rhinology. (2020) 58(3):213–7. 10.4193/Rhin19.468 - DOI - PubMed
1. Delemarre T, Holtappels G, De Ruyck N, Zhang N, Nauwynck H, Bachert C, et al. Type 2 inflammation in chronic rhinosinusitis without nasal polyps: another relevant endotype. J Allergy Clin Immunol. (2020) 146(2):337–43.e6. 10.1016/j.jaci.2020.04.040 - DOI - PubMed
1. Bachert C, Zhang N, Holtappels G, De Lobel L, van Cauwenberge P, Liu S, et al. Presence of IL-5 protein and IgE antibodies to staphylococcal enterotoxins in nasal polyps is associated with comorbid asthma. J Allergy Clin Immunol. (2010) 126(5):962–8. 10.1016/j.jaci.2010.07.007 - DOI - PubMed

LinkOut - more resources

Full Text Sources

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Affiliations

Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources