Multidisciplinary care for people with asthma

Rafi Thakjan, MD, MPH, FAAAAI, FACAAI: That’s a lot for a single medical professional. That said, there are differences between specialists, primary care physicians, and mid-career practitioners. Dr. Chase, how often are people with moderate-to-severe asthma managed by primary care physicians and by specialists who have more time? And whether you know it or not, how often do they end up in the emergency room or emergency room? What does that picture look like?

Nicole Chase, MD, FAAP, FAAAAI, FACAAI: All in all, the answer is probably something we all might wish we were different…. Most people with moderate to severe asthma are generally managed by primary care providers. It’s not that they are inherently wrong. But I think, as Dr. White alluded to, when patients feel good, they may even stop complaining about their needs from the healthcare system. They may or may not take their medication as prescribed. Realistically, however, patients managed by primary care providers tend to be treated with systemic corticosteroids more frequently. And this is one of the things that the experts do differently. Regarding baseline levels of control in asthmatics, we set the threshold of normality very low. We follow his two second rule. Exacerbations or symptoms occurring twice a month at night or twice a week during the day are undesirable. After all, when patients are sick, it is often easiest to seek care wherever they can if they are guided by their primary care provider. It could be that healthcare provider, but it could also be other places such as emergency medicine or emergency departments. I don’t think patients really want to stop caring for their symptoms. However, since this is a relapsing-remitting disease, there is no need to consider the need for a specialist when you are feeling well. But I think these patients should at least have the opportunity to see a specialist. What we offer as experts is not only management, but also a review of the diagnosis to confirm that this is asthma. We also offer additional conditions for investigational treatments and investigational tools such as exhaled nitric oxide and spirometry. Get objective data to help manage your patients.

I think there are too many answers to your questions about emergencies, visits and hospitalizations. Patients tend to seek treatment the fastest way possible, especially if there is a wait to see a specialist. It is very easy to determine that if you are currently feeling unwell, you will probably seek medical attention more urgently. As for when people with asthma should see a specialist, the guidelines say that people can be referred to a specialist at any time. This is really something to keep in mind. As specialists, we work very often with our providers. Otherwise, there is no reason why patients should not be expected to see their primary care physician, but we need to obtain objective data, plan treatment and see if it works for the patient. , and then I think you can bear the burden of re-evaluating. As time goes by. In addition, it offers long-term options that may differ from those faced by primary care providers.

Rafi Thakjan, MD, MPH, FAAAAI, FACAAI: very well said. After all, only a fraction of the asthma patients we speak of need special care, proper care, and guidance to optimal treatment. And like you said, first of all you have to make sure it’s the correct diagnosis. Because there are many other mimics, including immune pathways, that can reach completely different dimensions. I always say that asthma is like a teapot on the stove and asthma can be tricked. It’s probably bubbly, but when the wheezing starts it may be too late. It’s usually warm. It never turns off completely. It’s a chronic condition. From my colleagues Dr. White and Dr. Siri, have you ever told your primary care colleagues to refer you sooner, sooner, or does it just come naturally?

Dareen D. Siri, MD, FAAAI, FACAAI: Dr. White, would you like to take it?

Andrew White, M.D.: Great question. To be honest, there’s probably not enough communication between us and primary care. There will probably be a small group of people who get referrals, but with a larger group it might be even more controversial.

Dr. Chase, when you were talking about the possibility of early referral, I was wondering if there were actually a lot of patients who weren’t on controller therapy for asthma, but ended up going to the emergency department or , In some cases, you will be hospitalized once. one year. But the rest of the year is “mild” in some sense, but it’s not really mild asthma if it’s happening. This is a message that as a profession we could be able to better communicate and work a little more closely with our primary care colleagues.

Dareen D. Siri, MD, FAAAI, FACAAI: Your comments really resonated with me as an expert, allergist and immunologist. Many patients move from clinic to clinic and we do not have complete information about what they are going through. Sure, from what I just mentioned, I think we’re thinking about 10% of our patients, people with severe asthma, but he makes up 40% of our visits. Detecting them early, before they really show symptoms, before they start complaining and losing lung function in their 50s and 60s, and moderate to severe stages in their teens, 20s, and 30s. If you can be more aggressive with. Then perhaps some of these terrible consequences could be prevented. This is very good in that it encourages doctors to make early referrals.

Nicole Chase, MD, FAAP, FAAAAI, FACAAI: Dr. Siri, as you said, in terms of phenotypes and endotypes, we can do that on every visit. In a way, we can pretty much predict where these patients are going to go. I think we’ve all been surprised at some point when we see someone who seemed very stable suddenly became unstable for some other reason, or vice versa. However, we especially need to focus more on the data we get at each specific visit so that we can show who we are paying attention to regarding the high risk of transitioning to moderate or severe asthma. I have.

Edited transcript for clarity

#Multidisciplinary #care #people #asthma

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