Section of Allergy and Immunology, Department of Medicine, Penn State College of Medicine, Hershey, PA 17033, USA.
Section of Allergy and Immunology, Department of Medicine and Pediatrics, Penn State College of Medicine, Hershey, PA 17033, USA.
Int J Environ Res Public Health. 2020 Dec 18;17(24):9482. doi: 10.3390/ijerph17249482.
Worldwide, asthma-related healthcare cost remains a major burden. Individuals with severe asthma account for 50% of that cost. Although they are expensive, biologics such as anti-IL5 and anti-IgE agents promise cost-effectiveness when judiciously used to decrease asthma-related hospitalization and the debilitating side effects of systemic corticosteroids. Before considering biologics to treat patients with asthma, current guidelines recommend confirmation of asthma and control of comorbid diseases. Diagnostic confirmation of asthma can be challenging among individuals with severe asthma. In this quality assessment study, we determined the frequency of objective asthma confirmation and addressing of comorbidities prior to starting biologics at a group practice of allergists and immunologists. We surveyed our specialty providers to understand habit(s) leading to the observed results. We identified 40 adult patients who started on biologic modifiers for asthma over the past 5 years. Only 58% of these patients had a proper diagnosis of asthma. Providers underutilized several diagnostic methods that may prove useful in confirming asthma diagnosis in this patient population. The factors contributing to poor asthma control were rarely addressed. A sense of urgency to initiate biologics was the primary reason for the observed results. Further interventions are needed to improve asthma diagnosis and management prior to the initiation of biologic therapeutics.
在全球范围内，与哮喘相关的医疗保健费用仍然是一个主要负担。严重哮喘患者占这些费用的 50%。尽管生物制剂（如抗 IL-5 和抗 IgE 制剂）昂贵，但如果明智地使用以减少与哮喘相关的住院治疗和全身皮质类固醇的致残副作用，它们具有成本效益。在考虑使用生物制剂治疗哮喘患者之前，现行指南建议确认哮喘并控制合并症。在严重哮喘患者中，哮喘的诊断确认可能具有挑战性。在这项质量评估研究中，我们在一组过敏症和免疫学家的实践中，确定了在开始使用生物制剂之前，客观确认哮喘和解决合并症的频率。我们调查了我们的专科医生，以了解导致观察结果的习惯。我们确定了过去 5 年中开始使用生物调节剂治疗哮喘的 40 名成年患者。这些患者中只有 58%有适当的哮喘诊断。提供者很少使用几种可能有助于在该患者人群中确认哮喘诊断的诊断方法。导致哮喘控制不佳的因素很少得到解决。启动生物制剂的紧迫感是观察结果的主要原因。在开始使用生物疗法之前，需要进一步干预以改善哮喘的诊断和管理。
