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Backer V, Cardell LO, Lehtimäki L, Toppila-Salmi S, Bjermer L, Reitsma S, Hellings PW, Weinfeld D, Aanæs K, Ulrik CS, Braunstahl GJ, Aarli BB, Danielsen A, Kankaanranta H, Steinsvåg S, Bachert C. Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions. FRONTIERS IN ALLERGY 2023; 4:1052386. [PMID: 36895864 PMCID: PMC9989256 DOI: 10.3389/falgy.2023.1052386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Accepted: 01/17/2023] [Indexed: 02/25/2023] Open
Abstract
Background Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines. Methods Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions. Results Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified. Conclusion This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.
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Affiliation(s)
- Vibeke Backer
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Lars Olaf Cardell
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland.,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Sanna Toppila-Salmi
- Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sietze Reitsma
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands
| | - Peter W Hellings
- Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.,Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium
| | - Dan Weinfeld
- Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden
| | - Kasper Aanæs
- Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.,Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.,Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands
| | - Bernt Bøgvald Aarli
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
| | - Arild Danielsen
- Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway
| | - Hannu Kankaanranta
- Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.,Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.,Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Sverre Steinsvåg
- Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway
| | - Claus Bachert
- Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.,Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.,Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China
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De Prins L, Raap U, Mueller T, Schmid-Grendelmeier P, Haase CH, Backer V, Fokkens W, Benoist LB, Prokopakis E, Doulaptsi M, Hopkins C, Claeys N, Teeling T, Cypers L, Cools L, Bjermer LH, Diamant Z, Wahn U, Scadding G, Bachert C, Walther P, Patel SR, Van Staeyen E, Hellings P. White Paper on European Patient Needs and Suggestions on Chronic Type 2 Inflammation of Airways and Skin by EUFOREA. FRONTIERS IN ALLERGY 2022; 3:889221. [PMID: 35769567 PMCID: PMC9234878 DOI: 10.3389/falgy.2022.889221] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/14/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundType 2 inflammation underlies the chronicity of disease in subgroups of patients with asthma, chronic rhinosinusitis with nasal polyps (CRSwNP) and atopic dermatitis (AD), that often co-exist. Although several studies have investigated the unmet needs of asthma, AD and CRSwNP as such, little is known about the similarities and differences in experiences and perspectives of the current management of patients with comorbid Type 2 inflammatory diseases.AimsTo improve insight into the common and organ-specific needs of patients with Type 2 inflammation and comorbidities, allowing the formulation of recommendations to better address these needs in the future.MethodologyThis qualitative study was conducted between July 2021 and December 2021 using semi-structured face-to-face or telephone interviews with patients suffering from year-long severe chronic Type 2 inflammation and at least one co-morbid inflammatory condition. Seven participating academic centers in Europe interviewed asthma (Copenhagen and Leuven), CRSwNP (London, Amsterdam and Crete) and/or AD (Oldenburg and Zurich) patients on patient characteristics, disease severity, shortcomings of current care pathways and suggestions for improvement of care. Transcripts were analyzed using an inductive thematic analysis approach.ResultsEighty-one patients with severe Type 2 inflammation and comorbidities were interviewed. Similar needs were recognized by patients with Type 2 inflammation, with both a lack of coordination in care and a lack of a real cure reported as being most frustrating. However, several needs are specific to asthma, CRSwNP and AD. Suggestions for improvement of care were generic across diseases, such as the implementation of a multidisciplinary approach, the improved facilitation of access to better treatments, the increase of general awareness on disease burden, and better educational programs for healthcare providers and patients. Of note, patients with CRSwNP also stated the need for alternatives to sinus surgery, whereas patients with asthma requested better medical care to prevent exacerbations and patients with AD would warmly welcome the reimbursement of emollients.ConclusionPatients with asthma, CRSwNP and AD have shared unmet needs that need to be addressed by physicians, the academic community and health policy makers. This survey provides unique recommendations made by patients for the implementation of better care.
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Affiliation(s)
- Louise De Prins
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Ulrike Raap
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
- Department of Dermatology, Klinikum Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Tara Mueller
- Division of Experimental Allergology and Immunodermatology, University of Oldenburg, Oldenburg, Germany
- Department of Dermatology, Klinikum Oldenburg, University of Oldenburg, Oldenburg, Germany
| | - Peter Schmid-Grendelmeier
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Dermatology, Allergy Unit, University Hospital of Zurich, Zurich, Switzerland
| | - Christiane H. Haase
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Vibeke Backer
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Wytske Fokkens
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Linda B. Benoist
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
| | - Emmanuel Prokopakis
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Maria Doulaptsi
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Crete School of Medicine, Heraklion, Crete, Greece
| | - Claire Hopkins
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Guy's and St Thomas' Hospital, London Bridge Hospital, London, United Kingdom
| | - Nele Claeys
- EUFOREA Patient Advisory Board Chairs, Brussels, Belgium
| | - Thijs Teeling
- EUFOREA Patient Advisory Board Chairs, Brussels, Belgium
| | - Lindsay Cypers
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- *Correspondence: Lindsay Cypers
| | - Leen Cools
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
| | - Leif H. Bjermer
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Zuzana Diamant
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Ulrich Wahn
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Glenis Scadding
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Claus Bachert
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium
| | - Peter Walther
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Sunni R. Patel
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Elizabeth Van Staeyen
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
| | - Peter Hellings
- Department of Otorhinolaryngology, EUFOREA Scientific Expert Team Members, Brussels, Belgium
- Department of Otorhinolaryngology, Head and Neck Surgery, Universitair Ziekenhuis Leuven, Leuven, Belgium
- Department of Otorhinolaryngology, Head & Neck Surgery, Academic Medical Center (AMC), Amsterdam, Netherlands
- Upper Airways Research Laboratory, Department of Otorhinolaryngology, University of Ghent, Ghent, Belgium
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