Recommendations from a Canadian Delphi consensus study on best practice for optimal referral and appropriate management of severe asthma

Allergy, Asthma & Clinical Immunology

Research

V. Foran¹  C. Connors²  D. Dorscheid³  G. Dyck⁴  S. Waserman⁵  L. Connors⁶  M. Bhutani⁷  C. K. N. Chan⁸  A. G. Kaplan⁹  J. Reynolds^1,10  K. Godbout^1,11 

[1] Canadian Anesthesiologists’ Society, Asthma Canada, M4S 2Z2, Toronto, ON, Canada;Canadian Network for Respiratory Care, Bolton, Canada;Centre for Heart Lung Innovation, St. Paul’s Hospital, V6Z 1Y6, Vancouver, BC, Canada;Clearspring Medical Clinic, Steinbach, MB, Canada;Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada;Department of Medicine, Dalhousie University, Halifax, NS, Canada;Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Western Canada, Edmonton, AB, Canada;Faculty of Medicine, University of Toronto, Toronto, ON, Canada;Family Physician Airways Group of Canada, Respiratory Effectiveness Group, Department of Family and Community Medicine, University of Toronto, L4G 1N2, Toronto, Canada;Interim CEO, Asthma Canada, M4S 2Z2, Toronto, ON, Canada;Quebec Heart and Lung Institute, Laval University, Quebec City, Canada;

关键词: Asthma;    Consensus development;    Biologics;    Consultation and referral;    Primary care;    Health care;    Canada;   

DOI  :  10.1186/s13223-023-00767-6

 received in 2022-12-29, accepted in 2023-02-02,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundIn Canada, severe asthma affects an estimated 5–10% of people with asthma and is associated with frequent exacerbations, poor symptom control and significant morbidity from the disease itself, as well as the high dose inhaled, and systemic steroids used to treat it. Significant heterogeneity exists in service structure and patient access to severe asthma care, including access to biologic treatments. There appears to be over-reliance on short-acting beta agonists and frequent oral corticosteroid use, two indicators of uncontrolled asthma which can indicate undiagnosed or suboptimally treated severe asthma. The objective of this modified Delphi consensus project was to define standards of care for severe asthma in Canada, in areas where the evidence is lacking through patient and healthcare professional consensus, to complement forthcoming guidelines.MethodsThe steering group of asthma experts identified 43 statements formed from eight key themes. An online 4-point Likert scale questionnaire was sent to healthcare professionals working in asthma across Canada to assess agreement (consensus) with these statements. Consensus was defined as high if ≥ 75% and very high if ≥ 90% of respondents agreed with a statement.ResultsA total of 150 responses were received from HCPs including certified respiratory educators, respirologists, allergists, general practitioners/family physicians, nurses, pharmacists, and respiratory therapists. Consensus amongst respondents was very high in 37 (86%) statements, high in 4 (9%) statements and was not achieved in 2 (5%) statements. Based on the consensus scores, ten key recommendations were proposed. These focus on referrals from primary and secondary care, accessing specialist asthma services, homecare provision for severe asthma patients and outcome measures.ConclusionsImplementation of these recommendations across the severe asthma care pathway in Canada has the potential to improve outcomes for patients through earlier detection of undiagnosed severe asthma, reduction in time to severe asthma diagnosis, and initiation of advanced phenotype specific therapies.

【 授权许可】

CC BY   
© The Author(s) 2023

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