A Structured Approach to Specialist-referred Difficult Asthma Patients Improves Control of Comorbidities and Enhances Asthma Outcomes

Tay, Tunn Ren; Lee, Joy; Radhakrishna, Naghmeh; Hore‐Lacy, Fiona; Stirling, Robert; Hoy, Ryan; Dabscheck, Eli; O’Hehir, Robyn E; Hew, Mark

doi:10.1016/j.jaip.2016.12.030

Cited by 58 publications

(53 citation statements)

References 54 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…A total of six studies were classified as experimental/outcome studies. The outcomes of the experimental/outcome studies ranged from distinguishing difficult‐to‐treat asthma from treatment‐resistant asthma to improvement in asthma outcomes . No studies in this cluster were randomized controlled trials (RCT) or had control comparisons.…”

Section: Resultsmentioning

confidence: 99%

“…Medians were used if means were not reported, which is considered the best estimator in samples over 25 . Three outcome studies were included in the meta‐analysis . Exacerbation counts were reported pre‐ and post‐intervention in two studies .…”

Section: Methodsmentioning

confidence: 99%

“…Three outcome studies were included in the meta‐analysis . Exacerbation counts were reported pre‐ and post‐intervention in two studies . In one study, exacerbations were not explicitly reported, so number of prednisone doses pre‐ and post‐intervention were considered to be an exacerbation.…”

Section: Methodsmentioning

confidence: 99%

See 2 more Smart Citations

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

View full text Add to dashboard Cite

The management of severe asthma is complex. Multidimensional assessment (MDA) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma-related outcomes. We identified 26 studies and classified these based on study type (cohort/cross-sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co-morbidities and risk factors). The airway domain had the largest number of traits assessed (mean AE SD = 4.2 AE 1.7) compared with co-morbidities (3.6 AE 2.2) and risk factors (3.9 AE 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co-morbidities were psychological dysfunction, sinusitis (both 73%) and gastro-oesophageal reflux disease (GORD; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma-related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.

show abstract

Section: Resultsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

et al. 2017

View full text Add to dashboard Cite

show abstract

“…Suitable mechanisms need to be developed to manage demand as the severe asthma service expands. Consultative asthma services using a model in which patients are returned to referring specialists or primary care after comprehensive assessment and stabilisation may be more sustainable than services that manage all patients indefinitely . Alternatively, a shared‐care model between public and private care providers could be expanded as a way to share and optimise resources.…”

Section: Current Models Of Care For Severe Asthmamentioning

confidence: 99%

Managing patients with severe asthma in Australia: Current challenges with the existing models of care

Chung

Hew

Bardin

et al. 2018

Internal Medicine Journal

Self Cite

View full text Add to dashboard Cite

Severe asthma leads to debilitating symptoms for patients and excessive socioeconomic burden for the community. Comprehensive models of care are required to address complex issues, risk factors and comorbidities in patients with severe asthma, and to identify patients most appropriate for specialised treatments. Dedicated severe asthma services improve asthma control, reduce asthma exacerbations and hospital admissions, and improve quality of life. Currently, diverse models of care exist for managing severe asthma across Australia. Most referrals to severe asthma services are from respiratory physicians seeking a second opinion or from primary care for poorly controlled asthma. Despite benefits of specialised severe asthma services, many patients are not referred and resources are limited, often resulting in long waiting times. Patient referral is often unstructured and there are considerable variations in the management of severe asthma with limited access to other health care professionals such as speech pathologists and dieticians, and restricted scope to optimise patient work‐up before referral. Ongoing communication between the specialist and referring clinician is essential for continuity of care but is often lacking. Referral pathways can be optimised by developing referral criteria and guidelines to triage patients with severe asthma and to improve resource efficiency. Additional education and tools for assessing and managing severe asthma are needed, and mechanisms should be developed for involving primary care in the management of stabilised patients. Strategies to increase patient access to multidisciplinary services are recommended.

show abstract

“…11,12 As an extension of this service, we developed a multidisciplinary Middle Airway Clinic to systematically assess and manage patients with suspected concurrent asthma and ILO. 11,12 As an extension of this service, we developed a multidisciplinary Middle Airway Clinic to systematically assess and manage patients with suspected concurrent asthma and ILO.…”

Section: Introductionmentioning

confidence: 99%

Diagnosis of concomitant inducible laryngeal obstruction and asthma

Lee

Tay

Paddle

et al. 2018

Clin Experimental Allergy

Self Cite

View full text Add to dashboard Cite

show abstract

A Structured Approach to Specialist-referred Difficult Asthma Patients Improves Control of Comorbidities and Enhances Asthma Outcomes

Cited by 58 publications

References 54 publications

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

Multidimensional assessment of severe asthma: A systematic review and meta‐analysis

Managing patients with severe asthma in Australia: Current challenges with the existing models of care

Diagnosis of concomitant inducible laryngeal obstruction and asthma

Contact Info

Product

Resources

About