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) |