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Table 1 Results of the survey “Management of patients with asthma and severe asthma” of the Inter-Regional Section of SIAAIC

From: Management of patients with severe asthma: results from a survey among allergists and clinical immunologists of the Central Italy Inter-Regional Section of SIAAIC

Questions

% (N° resp)

1. Which is the percentage of asthmatics you are following and treating who are controlled?

 • Less than 30%

2% (1)

 • 30 to 50%

10% (4)

 • More than 50%

88% (35)

2. Which is the tool you use to evaluate asthma control in outpatient patients?

 • ACT

32% (13)

 • PEF monitoring

0% (0)

 • Interview

35% (14)

 • Spirometry

32% (13)

 • FeNO

0% (0)

3. Which is the most frequent cause of uncontrolled asthma in the real-life?

 • Inadequate management of comorbidities (gastroesophageal reflux, nasal polyposis, obesity, …)

15% (6)

 • Non-adherence to treatment

60% (24)

 • Incorrect use of devices

8% (3)

 • Inadequate therapy in relation to severity level

5% (2)

 • Lack of background therapy

12% (5)

4. Which is the best method in your opinion to monitor adherence to background therapy (ICS, LABA, LAMA, anti-leukotriene)?

 • Ask the patient directly

62% (25)

 • Ask the general practitioner to verify numbers of drug prescriptions through the database

12% (5)

 • Use of Smart devices able to monitor drug usage

15% (6)

 • Adherence cannot be monitored

0% (0)

 • By FeNO measurement

10% (4)

5. How long do you spend time (on average) to explain the correct use of the inhalation device?

 • Between 2 and 5 min

65% (26)

 • Over 5 min

22% (9)

 • I don't always have time to explain the device

12% (5)

 • Demand to the general practitioner

0% (0)

6. In your clinical experience, how many patients may be treated with flexible doses of inhalation therapy, according to the MART/SMART scheme?

 • 0–25%

52% (21)

 • 25–50%

25% (10)

 • 50–75%

20% (8)

 • 75–100%

2% (1)

7. In your clinical practice which one of the following definitions is the first to identify a patient with severe asthma?

 • Uncontrolled patient with medium–high doses ICS + other controller

15% (6)

 • Patient continuously treated with oral steroids for at least 6 months

2% (1)

 • Frequent exacerbating patient despite maximal treatment

55% (22)

 • Patient with frequent access to Emergency Department and/or hospitalization

5% (2)

 • Patient treated with medium–high doses of ICS-LABA and frequent use of drug as needed (3–4 puffs/day)

22% (9)

8. In your clinical experience, how many asthmatic patients can be suitable for current biological therapies?

 • Less than 3%

35% (14)

 • Ranging between 3 and 5%

58% (23)

 • Above 5%

8% (3)

9. In your opinion, how should patients with severe refractory asthma be managed?

 • During normal outpatient activity

5% (2)

 • Organizing dedicated severe asthma clinics in the same hospital

60% (24)

 • It would be better to send patients with severe asthma to organized centers with a high specialized background

35% (14)

10. How long after following a patient with severe asthma refractory to maximal standard therapy (ICS, LABA, LAMA, leukotriene) do you evaluate the option of biologic therapy?

 • Since the first visit, if the patient shows the inclusion criteria for a biologic drug

42% (17)

 • I follow the patient changing therapies for 3–6 months and then I evaluate the biological treatment

52% (21)

 • I wait up to a year before considering biologic treatment

5% (2)

11. As a specialist, which one of the following is the main therapeutic goal of a biologic therapy for severe asthma?

 • Reduction in exacerbations

32% (13)

 • Reduction of systemic steroid intake

18% (7)

 • Improvement of quality of life

25% (10)

 • Improvement of asthma control, assessed through ACT

12% (5)

 • Improvement of respiratory function

12% (5)

12. Which is the main result that patient with severe refractory asthma expects from inhalation treatment?

 • Reduced number of exacerbations

15% (6)

 • Reduced need of emergency department visits or hospitalization for asthma

8% (3)

 • Reduced use of systemic steroids with therefore reduced side effects

2% (1)

 • Reduced symptoms limiting the everyday quality of life (e.g. sleep quality, effort dyspnoea,…)

75% (30)

13. Once you have started a biologic therapy how often do you follow the patient during the first year?

 • The patient is visited every month with personal verification of both the course of therapy and clinical outcomes

45% (18)

 • The patient is fully re-evaluated once a month in the first 3–6 months, then every 6 months

52% (21)

 • Once therapy is set up, visits are arranged every 6 months. In the meantime, the patient’s assessment is carried out by the nursing staff

2% (1)

14. In your opinion, once stabilization is achieved in a severe asthmatic patient, how often is the outpatient monitoring necessary?

 • Every 3 months

48% (19)

 • Every 6 months

48% (19)

 • Every 12 months

5% (2)

15. To date in Italy anti IgE and anti IL5 biologics are available in well-codified phenotypes of asthma. Which is the basis of your choice in the case of patients with inclusion criteria for both therapies?

 • Whenever both biologics are indicated, I prefer anti IgE because I think that allergy is the main driver of the inflammatory process

15% (6)

 • Whenever both biologics are indicated I prefer anti IL5 because I consider eosinophils the main drivers of the inflammatory process

10% (4)

 • I choose accordingly to the patient's comorbidities (e.g. presence of eosinophilic nasal polyposis, vasculitis, urticaria, etc.)

72% (29)

 • I choose accordingly to practical aspects: cost NHS therapy, posology, etc.

2% (1)

16. Which is the role of the general practitioner in the management of patients with severe asthma?

 • Encourage the early recognition of these patients to be sent to specialized centers

28% (11)

 • Monitor adherence to the background therapy

2% (1)

 • Monitor patient's clinical status, e.g. systematically collecting agreed parameters

5% (2)

 • All previous

65% (26)

17. In your opinion, which one could be the first feasible action promoted by a Scientific Society to favour awareness of the patients about their pathology and possible therapeutic choices?

 • To carry on meetings with patient groups or patient associations

20% (8)

 • To produce training booklets to be delivered to patient or care-giver at the time of the visit

8% (3)

 • To promote training courses for general practitioners

48% (19)

 • To carry on media campaigns of disease awareness

25% (10)