Protocol for severe asthma gains scientific tick

Severe asthma can necessitate hospitalization.
Monash-Alfred researchers have tested an improved
protocol. Image: Breathinstephen

by Anne Crawford

A Monash University study evaluating approaches to treating the most challenging asthma patients has tested and confirmed a protocol that enhances asthma outcomes and improves quality of life. Its authors hope the protocol may act as a benchmark approach for treatment elsewhere.

The study, by researchers in The Alfred Hospital and CCS’s Department of Allergy, Clinical Immunology and Respiratory medicine (AIRmed) and others, sought to scientifically evaluate the structured approach to the management of ‘difficult asthma’ being used at AIRmed’s Difficult Asthma Clinic. Difficult asthma refers to the patients whose symptoms are so severe that even respiratory specialists find them hard to manage. At worst, it can be life-threatening.

The clinic has used the structured approach since it opened in 2014. Patients are questioned about their health in an initial four-hour visit and undergo a range of different investigations to work out an approach providing the best care for their asthma and also for any co-morbidities they might have, managed elsewhere at The Alfred. They are treated in shorter visits over six months, after which time the patients can either go back to their own respiratory physician or continue at the clinic.

Lead author Associate Professor Mark Hew from the Department of Epidemiology and Preventive Medicine said a holistic approach to the patient’s health was important as difficult asthma patients commonly had other conditions including obesity, sino-nasal disease, dysfunctional breathing (hyperventilation), vocal cord dysfunction and obstructive sleep apnoea.

The clinic also looked at how well the patients were adhering to their medication, testing this on small devices attached to their inhalers.

“We’re trying to make sure that asthma medication and treatment is as good as possible but also looking at the whole approach to the patient’s care, putting everything on the table,” Associate Professor Hew said.

The study, the fourth in a series of papers, set out to provide data on the approach as research on how best to deliver care for difficult asthma in Australia had previously been scarce, Associate Professor Hew said.

Of the 65 patients in the final analysis, most had an average of three co-morbidities that were treated. There was an overall improvement in asthma control, quality of life and the frequency of exacerbations of the disease, confirming the benefits of a structured approach coupled with targeted co-morbidity interventions.

“I think the study demonstrates that if we take a systematic approach to a very challenging problem we can achieve much better outcomes that in a general clinical environment,” Associate Professor Hew said.

“We think that the reason our protocol works is because we invest the time in the patients,” he said. “We know that these patients are very difficult to manage in outpatient clinics when the time pressure is great.

“We would like to think that we’ve established a beneficial approach that could be used elsewhere.”

The researchers included Professor Robin O’Hehir and Dr Eli Dabscheck.

Reference
Tay TR, Lee J, Radhakrishna N, Hore-Lacy F, Stirling R, Hoy R, Dabscheck E, O'Hehir R, Hew M. A Structured Approach to Specialist-referred Difficult Asthma Patients Improves Control of Comorbidities and Enhances Asthma Outcomes. 10.1016/j.jaip.2016.12.030. [Epub ahead of print]

Related feature
http://ccsmonash.blogspot.com.au/2016/10/congratulations-to-airmeds-difficult.html