Clinic for Lung Diseases Jordanovac, University Hospital Center Zagreb, Zagreb, Croatia.
School of Medicine, University of Zagreb, Zagreb, Croatia.
PLoS One. 2021 Jun 29;16(6):e0253468. doi: 10.1371/journal.pone.0253468. eCollection 2021.
Biologics have been proven efficacious for patients with severe asthma (SA). It is essential to diagnose such individuals correctly. This study was designed to survey pulmonologists to identify barriers to early diagnosis and subsequent appropriate use of biologics for SA in Croatia.
A pulmonologist group with expertise in SA developed the initial list of questions, with the final questionnaire created according to a 2-round Delphi method. The resulting survey consisted of 23 items consequently divided into 4 domains: 1) Pulmonologists' demographics and professional experiences; 2) Concerns about asthma management; 3) Attitudes toward SA diagnosis; and 4) Beliefs and attitudes regarding the use of biologics in managing SA. The given answers represented the respondents' estimates.
Eighty-four surveys were analyzed, with pulmonologists observing that general practitioners often inaccurately diagnose asthma and treat acute exacerbations. Although specialist centers are capably and correctly equipped, the time to diagnose patients with SA is approximately 3.5 months, with initial use of biologics delayed an additional 2 months. The primary indications for prescribing biologics are conventional therapy with oral glucocorticoids (91.7%) and frequent acute exacerbations (82.1%). In addition to improper diagnosis (64.3%), many patients with SA do not receive the indicated biologics owing to strict administrative directives for reimbursement (70.2%) or limited hospital resources (57.1%).
The limitations of this survey include the subjective nature of the collected data, the relatively small sample size, and the lack of the biologic efficacy evaluation.
Croatian pulmonologists observed that a significant number of patients with SA who are eligible for biologics are not prescribed them, largely because of an inaccurate and/or delayed diagnosis, a delayed referral to a specialist center, highly restrictive criteria for reimbursement, and/or institutional budgetary limitations.
生物制剂已被证明对严重哮喘（SA）患者有效。正确诊断此类患者至关重要。本研究旨在调查克罗地亚的肺科医生，以确定早期诊断和随后合理使用生物制剂治疗 SA 的障碍。
一组具有 SA 专业知识的肺科医生制定了初始问题清单，并根据两轮 Delphi 方法创建了最终问卷。由此产生的调查由 23 个项目组成，分为 4 个领域：1）肺科医生的人口统计学和专业经验；2）对哮喘管理的关注；3）对 SA 诊断的态度；4）对生物制剂治疗 SA 的使用的信念和态度。给出的答案代表了受访者的估计。
分析了 84 份调查，肺科医生观察到初级保健医生经常不准确地诊断哮喘并治疗急性加重。尽管专门中心有能力且正确配备，但诊断 SA 患者的时间约为 3.5 个月，最初使用生物制剂又延迟了 2 个月。开具生物制剂的主要指征是口服糖皮质激素的常规治疗（91.7%）和频繁的急性加重（82.1%）。除了诊断不当（64.3%）外，由于行政报销指令不当（70.2%）或医院资源有限（57.1%），许多 SA 患者未接受规定的生物制剂。
本调查的局限性包括所收集数据的主观性、样本量相对较小以及缺乏生物制剂疗效评估。
克罗地亚的肺科医生观察到，相当数量的符合生物制剂治疗条件的 SA 患者未接受治疗，主要原因是诊断不准确和/或延迟、向专科中心转介延迟、报销标准高度受限以及/或机构预算限制。
