Claudia Chaves Loureiro1, Manuel Branco Ferreira2, Jorge Ferreira3, Ricardo Lima4, João Marques5, Anna Sokolova6, Fernanda S Tonin7, Filipa Duarte Ramos8. 1. Pulmonology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Portugal; Centre of Pulmonology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address: uc40816@uc.pt. 2. Serviço de Imunoalergologia, Centro Hospitalar de Lisboa Norte, Lisboa, Portugal; Clínica Universitária de Imunoalergologia, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal. 3. Pulmonology Department, Hospital Pedro Hispano, Unidade Local de Saúde de Matosinhos, EPE, Vila Nova de Gaia, Portugal. 4. Pulmonology Department, Centro Hospitalar de Vila Nova de Gaia/Espinho, EPE, Vila Nova de Gaia, Portugal. 5. Immunology and Allergy Department, Centro Hospitalar de Lisboa Central, EPE, Lisboa, Portugal; CEDOC, Integrated Pathophysiological Mechanisms Research Group, Lisboa, Portugal. 6. Immunology and Allergy Department, Hospital Prof. Doutor Fernando Fonseca, EPE, Amadora, Portugal. 7. Pharmaceutical Sciences Postgraduate Program, Federal University of Parana, Brazil. 8. Department of Social Pharmacy, Faculty of Pharmacy, University of Lisboa, Lisboa, Portugal; EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Portugal.
Abstract
INTRODUCTION AND OBJECTIVES: We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. MATERIAL AND METHODS: A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-'strongly disagree'; 5-'strongly agree'). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). RESULTS: Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients' comorbidities was rated as imperative by all experts. CONCLUSIONS: These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients' adherence, and costs.
INTRODUCTION AND OBJECTIVES: We aimed to build a national consensus to optimize the use of oral corticosteroids (OCS) in severe asthma in Portugal. MATERIAL AND METHODS: A modified 3-round Delphi including 65 statements (topics on chronic systemic corticotherapy, therapeutic schemes, asthma safety and monitoring) was performed via online platform (October-November 2019). A five-point Likert-type scale was used (1-'strongly disagree'; 5-'strongly agree'). Consensus threshold was established as a percentage of agreement among participants ≥90% in the 1st round and ≥85% in the 2nd and 3rd rounds. The level of consensus achieved by the panel was discussed with the participants (face-to-face meeting). RESULTS: Forty-eight expert physicians in severe asthma (specialists in allergology and pulmonology) participated in the study. Almost half of the statements (28/65; 43.1%) obtained positive consensus by the end of round one. By the end of the exercise, 12 (18.5%) statements did not achieve consensus. Overall, 87% of physicians agree that further actions for OCS cumulative risk assessment in acute asthma exacerbations are needed. The vast majority (91.7%) demonstrated a favorable perception for using biological agents whenever patients are eligible. Most participants (95.8%) are more willing to accept some degree of lung function deterioration compared to other outcomes (worsening of symptoms, quality of life) when reducing OCS dose. Monitoring patients' comorbidities was rated as imperative by all experts. CONCLUSIONS: These results can guide an update on asthma management in Portugal and should be supplemented by studies on therapy access, patients' adherence, and costs.
Authors: Ji-Hyang Lee; Hyo-Jung Kim; Chan Sun Park; So Young Park; So-Young Park; Hyun Lee; Sang-Heon Kim; You Sook Cho Journal: Allergy Asthma Immunol Res Date: 2022-07 Impact factor: 5.096