Overcoming Barriers to the Effective Management of Severe Asthma in Italy.

People with severe asthma (SA) often have poor disease control and quality of life, and are at high risk of exacerbations, lung function decline and asthma-related death. The present expert opinion article aimed to identify unmet needs in the management of SA in Italy, and propose possible solutions to address these needs. At five multidisciplinary events in Italy, attendees identified factors that interfered with the effective management of SA and suggested how these barriers could be overcome. A core group of 12 Italian experts (pulmonologists, general practitioners, allergists, payers and patients) identified the main issues and proposed possible solutions based on the results from the meetings and relevant articles from the literature. We reviewed the gap between real-world practice and guidelines, oral corticosteroid overuse, SA-related mortality, and barriers to effective SA treatment. Common themes were lack of awareness about SA among both patients and clinicians, and lack of networking/information exchange between those involved in the treatment of SA. Participants agreed on the need to implement patient education and create multidisciplinary groups of specialists to improve SA management through multidisciplinary educational initiatives, meetings with local experts, development of a flow chart for referral/connection with local experts and specialized centers. Clinical instruments that might help specialists improve SA management included referral networks, integrated care pathways, phenotyping and treatment algorithms, exacerbation tracking, and examination of electronic medical records for patients with uncontrolled asthma. The following actions need to be implemented in Italy: i) maximize the use of advanced therapies, eg, biologics; ii) increase/improve education for physicians and patients; iii) improve multidisciplinary communication and care coordination; iv) introduce regional and local protocols for SA diagnosis and treatment; and v) change the structure of healthcare services to reduce specialist waiting times and facilitate access to biologic therapies.

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© 2021 Paggiaro et al.

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Dr. Paggiaro has received institutional and personal grants for research and education from ALK-Abellò, AstraZeneca, Chiesi, Glaxo Smith Kline, Guidotti, Menarini, Mundipharma, Novartis, and Sanofi. Dr. Trama reports grants from Fisioair Srl, grants from K. Link srl, grants from Mediacom Srl, grants from Boehringer Ingelheim, grants from Beneventi srl, outside the submitted work. Dr. Croce has received personal grants for research and education from AbbVie, Allergan, Astellas, Bayer, Becton Dickinson, Dompè, General Electric Healthcare, Gilead Science, Glaxo Smith Kline, Italfarmaco, MSD, Pfizer, Sanofi, Shire, Takeda, and ViiV Healthcare. Dr. Canonica has received research grants, been a speaker, or received advisory board fees from Menarini, Alk-Abellò, Allergy Therapeutics, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici, Genentech, Guidotti-Malesci, Glaxo Smith Kline, Hal Allergy, Mylan, Merck, Merck Sharp & Dome, Mundipharma, Novartis, Regeneron, Roche, Sanofi-Aventis, Sanofi-Genzyme, Stallergenes-Greer, UCB Pharma, Uriach Pharma, Valeas, and Vibor-Pharma. Dr. Barbaglia has no conflicts of interest to declare. Dr. Centanni has received institutional grants for research and education from AstraZeneca, Chiesi, Valeas and Boehringer Ingelheim and personal fees from Glaxo Smith Kline, Novartis, Chiesi, Menarini, AstraZeneca, Valeas, Boehringer Ingelheim, Guidotti Malesci. Dr. Desideri has no conflicts of interest to declare. Dr. Giustini has no conflicts of interest to declare. Dr. Micheletto has been a speaker, or received advisory board fees from AstraZeneca, Glaxo Smith Kline, Sanofi, Novartis, Menarini, Guidotti, Chiesi, Zambon, Berlin Chemie. Dr. Musarra has received advisory board fees from Glaxo Smith Kline, AstraZeneca, Sanofi Genzyme and Mylan. Dr. Scichilone has no conflicts of interest to declare. Dr. Zedda has received institutional and personal grants for research and education from AstraZeneca, Guidotti, Menarini. The authors report no other conflicts of interest in this work.