Introduction: 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.
Methods: 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.
Results and Conclusions: 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.

Keywords: biologic therapy, expert opinion, oral corticosteroids, severe asthma, unmet needs

中文翻译：

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克服意大利重症哮喘有效管理的障碍

引言：重症哮喘（SA）患者的疾病控制和生活质量通常较差，并且处于恶化、肺功能下降和哮喘相关死亡的高风险中。本专家意见文章旨在确定意大利 SA 管理中未满足的需求，并提出解决这些需求的可能解决方案。
方法：在意大利的五个多学科活动中，与会者确定了干扰 SA 有效管理的因素，并提出了如何克服这些障碍。由 12 名意大利专家（肺科医生、全科医生、过敏症专家、付款人和患者）组成的核心小组根据会议结果和文献中的相关文章确定了主要问题并提出了可能的解决方案。
结果和结论：我们回顾了现实世界实践和指南之间的差距、口服皮质类固醇过度使用、SA 相关死亡率以及有效 SA 治疗的障碍。共同的主题是患者和临床医生缺乏对 SA 的认识，以及参与 SA 治疗的人员之间缺乏网络/信息交流。与会者一致认为有必要实施患者教育并创建多学科专家小组，以通过多学科教育计划、与当地专家会面、制定转诊/与当地专家和专业中心联系的流程图来改善 SA 管理。可能帮助专家改善 SA 管理的临床工具包括转诊网络、综合护理途径、表型和治疗算法、恶化跟踪、对哮喘失控患者的电子病历进行检查。意大利需要采取以下行动： i) 最大限度地使用先进疗法，例如生物制剂；ii) 增加/改善对医生和患者的教育；iii) 改善多学科沟通和护理协调；iv) 为 SA 诊断和治疗引入区域和地方协议；v) 改变医疗保健服务的结构，以减少专科等待时间并促进获得生物疗法。iv) 为 SA 诊断和治疗引入区域和地方协议；v) 改变医疗保健服务的结构，以减少专科等待时间并促进获得生物疗法。iv) 为 SA 诊断和治疗引入区域和地方协议；v) 改变医疗保健服务的结构，以减少专科等待时间并促进获得生物疗法。

关键词：生物治疗，专家意见，口服皮质类固醇，严重哮喘，未满足的需求