Overcoming Barriers to the Effective Management of Severe Asthma in Italy

Figures & data

Table 1 Charter to Improve Patient Care in Severe Asthma

Principle
1	I deserve a timely, straightforward referral when my severe asthma cannot be managed in primary care.
2	I deserve a timely, formal diagnosis of my severe asthma by an expert team.
3	I deserve support to understand my type of severe asthma.
4	I deserve care that reduces the impact of severe asthma on my daily life and improves my overall quality of care.
5	I deserve not to be reliant on oral corticosteroids.
6	I deserve to access consistent quality care, regardless of where I live or where I choose to access it.

Note: Data from Menzies-Gow et al.²⁷

Table 2 Barriers to Effective Management of Severe Asthma in Italy According to Various Stakeholders

Barriers to Correct and Timely Diagnosis
According to GPs and pulmonary specialists	Failure to identify severe asthma
	Failure/delayed referral to a specialist by GPs
	Poor communication between GPs, specialists and first aid providers
	Lack of awareness of severe asthma among clinicians
According to patients and/or caregivers	Lack of patient awareness and self-management
	Poor treatment adherence
According to health system providers	Poorly structured clinics
	Long waiting lists
	Lack of collaboration between various specialists
	Lack of awareness of severe asthma in the wider society
Barriers to Effective Therapeutic Management
According to GPs and pulmonary specialists	Underuse and poor availability of biomarkers to guide treatment decisions
	Absence of an OCS-use monitoring system
	Underuse of phenotyping by specialists
	Treatment of acute phases only
	Failure to check adherence to therapy
According to patients and/or caregivers	Poor patient education and empowerment
	Fear of having to resort to using systemic corticosteroids
According to health system providers	Cost of biologic drugs
	Lack of real-world epidemiological data in Italy
	Absence of a structured network and lack of collaboration between GPs, specialist prescribers of biologic agents, and non-prescribing specialists
	Lack of key performance indicators
Barriers to Effective Follow-Up
According to GPs and pulmonary specialists	Lack of follow-up planning
	Poor communication about follow-up schedule and poor GP involvement
	Underuse of biomarkers to guide treatment decisions
According to patients and/or caregivers	Lack of trust between patients and clinicians
	Poor treatment adherence
According to health system providers	Absence of a structured network and lack of collaboration between GPs, specialist prescribers of biologic agents and non-prescribing specialists
	Logistic difficulties (distribution of centers in the area)
	Scarcity of economic and personnel resources
	Lack of key performance indicators

Abbreviations: GP, general practitioner; OCS, oral corticosteroids.

Table 3 The Impact of Various Barriers to Effective Management of Severe Asthma (Survey Results)

Barriers	Major Consequences
Delay in referral to a center with special expertise in the field of severe asthma	Risk of serious exacerbations
	Decreased quality of life
	Late diagnosis
Incorrect diagnosis	Risk of serious exacerbations
	Decreased quality of life
	Inappropriate treatment
Late diagnosis	Risk of serious exacerbations
	Decreased quality of life
	Disease progression/airway remodeling
	Increased mortality risk
Delay/failure to attend follow-up after receiving first aid treatment	Risk of serious exacerbations
	Inappropriate use of OCS
	Absence of monitoring of the number and severity of exacerbations
Absence of an OCS-use monitoring system	OCS overuse
	Adverse effects related to OCS use
	Delay in using alternative therapies
Lack/poor access to diagnostic tests	Late/incorrect diagnosis
	Inappropriate treatment
	Poor asthma control

Abbreviation: OCS, oral corticosteroids.

Table 4 Suggestions for Overcoming the Barriers to Effective Management of Severe Asthma

Target Audience	Suggestions
Pulmonary/allergy centers with the authority to prescribe biologic drugs	Creating dedicated agendas and preferential channels for patients with severe asthma
	Establishing a diagnostic-therapeutic pathway for severe asthma
	Conducting interdisciplinary internal meetings (otolaryngologist, psychologists, gastroenterologists, interventionists)
	Keeping clinical registries to support the network among centers
Pulmonologists/allergists without the authority to prescribe biologic drugs	Establishing collaboration between GPs/specialists who can prescribe biologic agents and specialists who cannot prescribe biologic agents
	Conducting regular training on referral criteria
	Conducting training to become a prescribing center
	Collaborating with specialists who treat comorbidities
Patients and caregivers	Improving public awareness of severe asthma
	Education about severe asthma in schools
	Supporting patients’ associations
	Providing support for scientific societies
GPs	Conducting refresher courses on severe asthma
	Creating a network with specialist centers
	Providing GPs with objective parameters for recognizing severe asthma (flow charts, alerts for indicators of uncontrolled asthma)
	Training in spirometry and diagnostic techniques
Emergency units	Improving identification of patients with severe asthma and facilitating their referral to appropriate specialists
	Improving training on how to recognize severe asthma
	Promoting collaboration within hospitals
	Promoting collaboration between first aid providers and biologic prescribing centers
Hospital pharmacists	Increasing the involvement of hospital pharmacists in the management of severe asthma
	Taking advantage of big data available to pharmacists (eg about over-prescription of OCS)
	Conducting video tutorials in pharmacies
	Providing spirometry assessments in hospital pharmacies
Payers	Establishing outpatient clinics dedicated to asthma
	Implementing Integrated Care Pathways
	Collection of Italian epidemiological data and conducting pharmacoeconomic analyses on the use of biologics
	Establishing regional networks
All target audiences	Creating a hub-and-spoke/collaborative network
	Providing preferential channels for specialist visits for patients with severe asthma
	Creating a network connecting all stakeholders at the regional level
	Imitating existing local best practices

Abbreviations: GP, general practitioner; OCS, oral corticosteroids.

Menzies-Gow A, Canonica GW, Winders TA, et al. A charter to improve patient care in severe asthma. Adv Ther. 2018;35(10):1485–1496. doi:10.1007/s12325-018-0777-y

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