The effect of the COVID-19 pandemic on severe asthma care in Europe: will care change for good?

Abstract

BackgroundThe COVID-19 pandemic has put pressure on health-care services forcing the reorganisation of traditional care pathways. We investigated how physicians taking care of severe asthma patients in Europe reorganised care, and how these changes affected patient satisfaction, asthma control and future care.MethodsIn this European-wide cross-sectional study, patient surveys were sent to patients with a physician-diagnosis of severe asthma, and physician surveys to severe asthma specialists between November 2020 and May 2021.Results1101 patients and 268 physicians from 16 European countries contributed to the study. Common physician-reported changes in severe asthma care included use of video/phone consultations (46%), reduced availability of physicians (43%) and change to home-administered biologics (38%). Change to phone/video consultations was reported in 45% of patients, of whom 79% were satisfied or very satisfied with this change. Of 709 patients on biologics, 24% experienced changes in biologic care, of whom 92% were changed to home-administered biologics and of these 62% were satisfied or very satisfied with this change. Only 2% reported worsening asthma symptoms associated with changes in biologic care. Many physicians expect continued implementation of video/phone consultations (41%) and home administration of biologics (52%).ConclusionsChange to video/phone consultations and home administration of biologics was common in severe asthma care during the COVID-19 pandemic, and was associated with high satisfaction levels in most but not all cases. Many physicians expect these changes to continue in future severe asthma care, though satisfaction levels may change after the pandemic.

Evaluation of real-world mepolizumab use in severe asthma across Europe: the SHARP experience with privacy-preserving federated analysis

“…This heterogeneity may be due to differences in reimbursement practices for biological therapies, to recommendations in national guidelines and therefore the eligibility criteria for biologics, or to preferences and choices of individual physicians. The differences in patient characteristics treated with mepolizumab before and during the pandemic may have influenced the extent to which some patients could or could not cope with remote care [ 22 ]. The heterogeneity of our population also illustrates that the definition of “severe asthma” does not appear to be used unambiguously.…”

“…We distinguished two separate study periods, as it was likely that the coronavirus disease 2019 (COVID-19) pandemic would have influenced the treatment of patients with mepolizumab in terms of initiation, modification and discontinuation of concomitant treatments, as well as outcomes such as the number of asthma exacerbations [ 22 ]. The first period was pre-pandemic and was defined by the initiation and follow-up of mepolizumab treatment between 1 January 2016 and 31 March 2020.…”

Safety of biologics in severe asthmatic patients with SARS‐CoV‐2 infection: A prospective study

“…To date, we cannot conclude that biologics have a protective role against adverse COVID-19 outcomes; however, we showed that the biologics administration is not cause of serious AEs or worsening of COVID-19. Moreover, these findings could have paved the way to a new management of patients with severe asthma and other chronic diseases on biologic therapy,34,35 also contributing to maintain a better control of severe forms of chronic diseases during SARS-CoV-2 infection in most patients and preventing the risk of exacerbation linked to treatment discontinuation. Moreover, the adoption of the self-administration can contribute to decrease chances of viral exposure in the clinic.…”