Diagnosis and treatment of adult asthma patients in Serbia: a 2022 experts group position statement

ABSTRACT

Introduction

Asthma is the most common non-communicable chronic lung condition across all ages. Epidemiological data indicate that many asthma patients in Serbia remain undiagnosed and untreated. The implementation of recent global advances in asthma management is limited due to the lack of a systematic approach, drug availability and regulatory affairs. In addition, the global coronavirus disease pandemic has posed a significant challenge, particularly in resource-limited settings.

Areas covered

In this paper, we propose an algorithm for treating adult asthma patients in Serbia. We performed PubMed database search on published asthma clinical trials and guidelines from 1 January 2015 to 10 March 2020. The consensus process incorporated a modified Delphi method that included two rounds of e-mail questionnaires and three rounds of national asthma expert meetings. We focus on 1) objective diagnosis of asthma, 2) the implementation of up-to-date therapeutic options, and 3) the identification and referral of severe asthma patients to newly established severe asthma centers.

Expert opinion

Regional specificities and variations in healthcare systems require the adaptation of evidence-based knowledge. Practical, clinically oriented algorithms designed to overcome local barriers in healthcare delivery may facilitate timely and adequate asthma diagnosis and the local implementation of current advances in asthma management.

KEYWORDS:

• Asthma
• middle-income country
• guidelines

Article highlights

• Using global recommendation as a basis, this article presents an expert position statement for asthma treatment in Serbia taking into account local epidemiology data and the structure of the healthcare system.

• Simple, straightforward algorithms were designed for the diagnosis, treatment, and referral of asthma patients to newly established severe asthma centers.

• The diagnostic algorithm is based on the updated ATS/ERS 2019 spirometry recommendations and includes DLCO in the initial diagnostic algorithm for patients with no variability/reversibility, restrictive impairment, or dyspnea on exertion.

• Due to the high prevalence of smoking in Serbia, efforts should be made to ensure smoking cessation, as smokers with asthma may not only have worse asthma control and faster loss of lung function but also may suffer from smoking-related comorbidities.

• Only partial reimbursement of controller medications is likely to be associated with cost-related non-adherence to asthma medications and SABA overuse, thus efforts should be made toward ensuring the use of ICS-containing treatments and providing free and accessible asthma treatment.

• Given the ongoing COVID-19 pandemic, a summary of the recommendations for the diagnosis and treatment of asthma during COVID-19 outbreaks is provided.

Abbreviations

ACQ – Asthma Control Questionnaire; ACT – Asthma Control Test; AIT – allergen immunotherapy; AR – allergic rhinitis; ATS-ERS – American Thoracic Society/European Respiratory Society; BCT – bronchial challenge test; COPD – chronic obstructive pulmonary disease; COVID-19 – coronavirus disease 2019; CT – computerized tomography; DLCO – diffusion capacity for carbon monoxide; DPI – dry powder inhaler; FeNO – fractional exhaled nitric oxide; FEV1 – forced expiratory volume in one second; FVC – forced vital capacity; GINA – Global Initiative for Asthma; GP – general practitioner; HDM – house dust mites; ICS – inhaled corticosteroids; Ig – immunoglobulin; IL – interleukin; LABA – long-acting β₂-agonist; LAMA – long-acting muscarinic antagonist; LLN – lower limit of normal; LTRA – leukotriene receptor antagonists; MART – maintenance and reliever therapy; MDI – metered-dose inhaler; NSAID – non-steroid anti-inflammatory drugs; OCS – oral corticosteroids; PEF – peak expiratory flow; SABA – short-acting beta 2 agonists; AMA – short-acting muscarinic antagonist; SLIT – sublingual immunotherapy

Acknowledgments

In loving memory of Associate Professor Vladimir Zugic, one of the founding members of the expert group. Dedicated to all health workers at the forefront of fighting the COVID-19 pandemic.

Declaration of interest

M. Vukoja reports fees for providing scientific advice and/or lecturing from Boehringer Ingelheim, Berlin-Chemie Menarini, Providens, and Astra Zeneca. I. Kopitovic reports fees for providing scientific advice and/or lecturing from Boehringer Ingelheim, Berlin-Chemie Menarini, Astra Zeneca, TEVA, Providens, and PharmaS. B. Zvezdin reports fees for providing scientific advice and/or lecturing from Astra Zeneca, Providens, Berlin-Chemie Menarini, Novartis, Teva Pharmaceuticals, and Sandoz. B. Milenkovic has received honoraria for consulting and presenting from AstraZeneca, Berlin-Chemie, Boehringer-Ingelheim, and Novartis. V. Tomic-Spiric has received honoraria for consulting and lecturing from AstraZeneca, Berlin-Chemie Menarini, and Novartis. I. Cekerevac reports lecture fees from Boehringer Ingelheim, AstraZeneca, and Providens. S. Hromis has received honoraria for consulting and lecturing from AstraZeneca, Berlin-Chemie Menarini, Providens, and Novartis. Dimic Janjic reports consulting and lecture fees from Boehringer Ingelheim, AstraZeneca, and Providens. M. Stjepanovic reports consulting and lecture fees from Boehringer Ingelheim, AstraZeneca, Providens, and Berlin-Chemie Menarini. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/17476348.2022.2153674

Additional information

Funding

This paper was not funded.