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Wellmann N, Marc MS, Stoicescu ER, Pescaru CC, Trusculescu AA, Martis FG, Ciortea I, Crisan AF, Balica MA, Velescu DR, Fira-Mladinescu O. Enhancing Adult Asthma Management: A Review on the Utility of Remote Home Spirometry and Mobile Applications. J Pers Med 2024; 14:852. [PMID: 39202043 PMCID: PMC11355136 DOI: 10.3390/jpm14080852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Revised: 07/25/2024] [Accepted: 08/09/2024] [Indexed: 09/03/2024] Open
Abstract
Asthma is a prevalent chronic disease, contributing significantly to the global burden of disease and economic costs. Despite advances in treatment, inadequate disease management and reliance on reliever medications lead to preventable deaths. Telemedicine, defined as the use of information and communication technology to improve healthcare access, has gained global attention, especially during the COVID-19 pandemic. This systematic review examines the effectiveness of home monitoring systems in managing severe asthma. A systematic literature search was conducted in PubMed, Web of Science, Scopus, and Cochrane Library, focusing on studies from 2014 to 2024. Fourteen studies involving 9093 patients were analyzed. The results indicate that telemedicine, through tools such as mobile applications and portable spirometers, positively impacts asthma control, self-management, and quality of life. Home spirometry, in particular, shows strong agreement with clinic spirometry, offering a feasible alternative for continuous monitoring. Digital coaching and machine learning-based telemedicine applications also demonstrate significant potential in improving asthma outcomes. However, challenges such as technology accessibility, data privacy, and the need for standardized protocols remain. This review highlights the promise of telemedicine in asthma management and calls for further research to optimize its implementation and address existing barriers.
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Affiliation(s)
- Norbert Wellmann
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Monica Steluta Marc
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Emil Robert Stoicescu
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Research Center for Pharmaco-Toxicological Evaluations, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
- Radiology and Medical Imaging University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square No. 2, 300041 Timisoara, Romania
| | - Camelia Corina Pescaru
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Ana Adriana Trusculescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Flavia Gabriela Martis
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Ioana Ciortea
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
| | - Alexandru Florian Crisan
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Research Center for the Assessment of Human Motion, Functionality and Disability (CEMFD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Madalina Alexandra Balica
- Doctoral School, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (E.R.S.); (I.C.); (M.A.B.)
- Infectious Diseases University Clinic, Department of Infectious Diseases, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
| | - Diana Raluca Velescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
| | - Ovidiu Fira-Mladinescu
- Center for Research and Innovation in Personalised Medicine of Respiratory Diseases (CRIPMRD), “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania; (N.W.); (C.C.P.); (A.A.T.); (F.G.M.); (A.F.C.); (D.R.V.); (O.F.-M.)
- Pulmonology University Clinic, “Victor Babes” University of Medicine and Pharmacy Timisoara, Eftimie Murgu Square 2, 300041 Timisoara, Romania
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van de Hei SJ, Kim CH, Honkoop PJ, Sont JK, Schermer TRJ, MacHale E, Costello RW, Kocks JWH, Postma MJ, van Boven JFM. Long-Term Cost-Effectiveness of Digital Inhaler Adherence Technologies in Difficult-to-Treat Asthma. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:3064-3073.e15. [PMID: 37406806 DOI: 10.1016/j.jaip.2023.06.051] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 06/14/2023] [Accepted: 06/19/2023] [Indexed: 07/07/2023]
Abstract
BACKGROUND Digital inhalers can monitor inhaler usage, support difficult-to-treat asthma management, and inform step-up treatment decisions yet their economic value is unknown, hampering wide-scale implementation. OBJECTIVE We aimed to assess the long-term cost-effectiveness of digital inhaler-based medication adherence management in difficult-to-treat asthma. METHODS A model-based cost-utility analysis was performed. The Markov model structure was determined by biological and clinical understanding of asthma and was further informed by guideline-based assessment of model development. Internal and external validation was performed using the Assessment of the Validation Status of Health-Economic (AdViSHE) tool. The INCA (Inhaler Compliance Assessment) Sun randomized clinical trial data were incorporated into the model to evaluate the cost-effectiveness of digital inhalers. Several long-term clinical case scenarios were assessed (reduced number of exacerbations, increased asthma control, introduction of biosimilars [25% price-cut on biologics]). RESULTS The long-term modelled cost-effectiveness based on a societal perspective indicated 1-year per-patient costs for digital inhalers and usual care (ie, regular inhalers) of €7,546 ($7,946) and €10,752 ($11,322), respectively, reflecting cost savings of €3,207 ($3,377) for digital inhalers. Using a 10-year intervention duration and time horizon resulted in cost savings of €26,309 ($27,703) for digital inhalers. In the first year, add-on biologic therapies accounted for 69% of the total costs in the usual care group and for 49% in the digital inhaler group. Scenario analyses indicated consistent cost savings ranging from €2,287 ($2,408) (introduction biosimilars) to €4,581 ($4,824) (increased control, decreased exacerbations). CONCLUSIONS In patients with difficult-to-treat asthma, digital inhaler-based interventions can be cost-saving in the long-term by optimizing medication adherence and inhaler technique and reducing add-on biologic prescriptions.
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Affiliation(s)
- Susanne J van de Hei
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands
| | - Chong H Kim
- Center for Pharmaceutical Outcomes Research, Skaggs School of Pharmacy and Pharmaceutical Sciences, University of Colorado, Denver, Colo
| | - Persijn J Honkoop
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Jacob K Sont
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
| | - Tjard R J Schermer
- Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands; Science Support Office, Gelre Hospitals, Apeldoorn, the Netherlands
| | - Elaine MacHale
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital, Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; General Practitioners Research Institute, Groningen, The Netherlands; Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands; Observational and Pragmatic Research Institute, Singapore
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Center of Excellence for Pharmaceutical Care Innovation, Padjadjaran University, Bandung, Indonesia; Department of Economics, Econometrics & Finance, University of Groningen, Faculty of Economics & Business, Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands; Department of Clinical Pharmacy & Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
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van de Hei SJ, Stoker N, Flokstra-de Blok BMJ, Poot CC, Meijer E, Postma MJ, Chavannes NH, Kocks JWH, van Boven JFM. Anticipated barriers and facilitators for implementing smart inhalers in asthma medication adherence management. NPJ Prim Care Respir Med 2023; 33:22. [PMID: 37208358 DOI: 10.1038/s41533-023-00343-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 05/05/2023] [Indexed: 05/21/2023] Open
Abstract
Smart inhalers are electronic monitoring devices which are promising in increasing medication adherence and maintaining asthma control. A multi-stakeholder capacity and needs assessment is recommended prior to implementation in healthcare systems. This study aimed to explore perceptions of stakeholders and to identify anticipated facilitators and barriers associated with the implementation of smart digital inhalers in the Dutch healthcare system. Data were collected through focus group discussions with female patients with asthma (n = 9) and healthcare professionals (n = 7) and through individual semi-structured interviews with policy makers (n = 4) and smart inhaler developers (n = 4). Data were analysed using the Framework method. Five themes were identified: (i) perceived benefits, (ii) usability, (iii) feasibility, (iv) payment and reimbursement, and (v) data safety and ownership. In total, 14 barriers and 32 facilitators were found among all stakeholders. The results of this study could contribute to the design of a tailored implementation strategy for smart inhalers in daily practice.
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Affiliation(s)
- Susanne J van de Hei
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Nilouq Stoker
- General Practitioners Research Institute, Groningen, the Netherlands
| | - Bertine M J Flokstra-de Blok
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
- General Practitioners Research Institute, Groningen, the Netherlands
- Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Charlotte C Poot
- Department of Primary Care and Public Health, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden, The Netherlands
| | - Eline Meijer
- Department of Primary Care and Public Health, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Primary Care and Public Health, Leiden University Medical Center, Leiden, The Netherlands
- National eHealth Living Lab, Leiden, The Netherlands
| | - Janwillem W H Kocks
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands
- General Practitioners Research Institute, Groningen, the Netherlands
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), Groningen, The Netherlands.
- Medication Adherence Expertise Center of the northern Netherlands (MAECON), Groningen, The Netherlands.
- Department of Clinical Pharmacy & Pharmacology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
- Centre for Medicine Use and Safety, Monash Institute of Pharmaceutical Sciences, Monash University, Melbourne, VIC, Australia.
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van de Hei SJ, Poot CC, van den Berg LN, Meijer E, van Boven JFM, Flokstra-de Blok BMJ, Postma MJ, Chavannes NH, Kocks JWH. Effectiveness, usability and acceptability of a smart inhaler programme in patients with asthma: protocol of the multicentre, pragmatic, open-label, cluster randomised controlled ACCEPTANCE trial. BMJ Open Respir Res 2022; 9:9/1/e001400. [PMID: 36522130 PMCID: PMC9756226 DOI: 10.1136/bmjresp-2022-001400] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 12/08/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Suboptimal asthma control is associated with incorrect inhaler use and poor medication adherence, which could lead to unfavourable clinical and economic outcomes. Smart inhaler programmes using electronic monitoring devices (EMDs) could support self-management and increase medication adherence and asthma control. However, evidence on long-term benefits and acceptability is scarce. This study aims to investigate the effectiveness of a smart inhaler asthma self-management programme on medication adherence and clinical outcomes in adults with uncontrolled asthma, to evaluate its acceptability and to identify subgroups who would benefit most based on patient characteristics. METHODS AND ANALYSIS This open-label cluster randomised controlled trial of 12 months will be conducted in primary care in the Netherlands. General practices will be randomly assigned to either intervention or control group. We aim to include 242 patients. The intervention consists of (1) an EMD attached to the patient's inhaler that measures medication use; (2) a smartphone application to set medication reminders, receive motivational messages and track asthma symptoms; and (3) a portal for healthcare professionals to view data on medication use. The control group is passively monitored by the EMD but cannot view their inhaler data or receive feedback. Eligible patients are adults with suboptimal controlled asthma (Asthma Control Questionnaire score ≥0.75) with evidence of non-adherence established by the EMD during a 6-week run-in period. Primary outcome is the difference in mean medication adherence between intervention and control group. Secondary outcomes include asthma control, asthma-related quality of life, exacerbations, acceptance, cost-effectiveness and whether the effect of the intervention on medication adherence and asthma control is modified by patient characteristics (eg, self-efficacy, medication beliefs and eHealth literacy).Trial registration numberNL7854.
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Affiliation(s)
- Susanne J van de Hei
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,General Practitioners Research Institute, Groningen, The Netherlands,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Liselot N van den Berg
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands,Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands,Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands
| | - Bertine M J Flokstra-de Blok
- General Practitioners Research Institute, Groningen, The Netherlands,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands,Department of Pediatric Pulmonology and Pediatric Allergology, Beatrix Children's Hospital, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Maarten J Postma
- Department of Health Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Janwillem W H Kocks
- General Practitioners Research Institute, Groningen, The Netherlands,Groningen Research Institute for Asthma and COPD (GRIAC), University of Groningen, University Medical Center Groningen, Groningen, Netherlands,Medication Adherence Expertise Center of the Northern Netherlands (MAECON), Groningen, The Netherlands,Observational and Pragmatic Research Institute, Singapore
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Rumi G, Canonica GW, Foster JM, Chavannes NH, Valenti G, Contiguglia R, Rapsomaniki E, Kocks JWH, De Brasi D, Braido F. Digital Coaching Using Smart Inhaler Technology to Improve Asthma Management in Patients With Asthma in Italy: Community-Based Study. JMIR Mhealth Uhealth 2022; 10:e25879. [PMID: 36322120 PMCID: PMC9669888 DOI: 10.2196/25879] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 04/01/2021] [Accepted: 05/20/2021] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Reliance on short-acting β-2 agonists and nonadherence to maintenance medication are associated with poor clinical outcomes in asthma. Digital health solutions could support optimal medication use and therefore disease control in patients with asthma; however, their use in community settings has not been determined. OBJECTIVE The primary objective of this study is to investigate community implementation of the Turbu+ program designed to support asthma self-management, including adherence to budesonide and formoterol (Symbicort) Turbuhaler, a combination inhaler for both maintenance therapy or maintenance and reliever therapy. The secondary objective is to provide health care professionals with insights into how patients were using their medication in real life. METHODS Patients with physician-diagnosed asthma were prescribed budesonide and formoterol as maintenance therapy, at a dose of either 1 inhalation twice daily (1-BID) or 2 inhalations twice daily (2-BID), or as maintenance and reliever therapy (1-BID and reliever or 2-BID and reliever in a single inhaler), and they received training on Turbu+ in secondary care centers across Italy. An electronic device attached to the patients' inhaler for ≥90 days (data cutoff) securely uploaded medication use data to a smartphone app and provided reminders, visualized medication use, and motivational nudge messages. Average medication adherence was defined as the proportion of daily maintenance inhalations taken as prescribed (number of recorded maintenance actuations per day or maintenance inhalations prescribed per day) averaged over the monitoring period. The proportion of adherent days was defined as the proportion of days when all prescribed maintenance inhalations were taken on a given day. The Wilcoxon test was used to compare the proportion of adherent days between patients in the maintenance regimen and patients in the maintenance and reliever regimen of a given dose. RESULTS In 661 patients, the mean (SD) number of days monitored was 217.2 (SD 109.0) days. The average medication adherence (maintenance doses taken/doses prescribed) was 70.2% (108,040/153,820) overall and was similar across the groups (1-BID: 6332/9520, 66.5%; 1‑BID and reliever: 43,578/61,360, 71.0%; 2-BID: 10,088/14,960, 67.4%; 2-BID and reliever: 48,042/67,980, 70.7%). The proportion of adherent days (prescribed maintenance doses/doses taken in a given day) was 56.6% (31,812/56,175) overall and was higher with maintenance and reliever therapy (1-BID and reliever vs 1-BID: 18,413/30,680, 60.0% vs 2510/4760, 52.7%; P<.001; 2-BID and reliever vs 2-BID: 8995/16,995, 52.9% vs 1894/3740, 50.6%; P=.02). Rates of discontinuation from the Turbu+ program were significantly lower with maintenance and reliever therapy compared with maintenance therapy alone (P=.01). CONCLUSIONS Overall, the high medication adherence observed during the study might be attributed to the electronic monitoring and feedback mechanism provided by the Turbu+ program.
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Affiliation(s)
- Gabriele Rumi
- Dipartimento di Scienze Mediche e Chirurgiche, Fondazione Policlinico Universitario A Gemelli IRCCS, Università Cattolica del Sacro Cuore - Medicina Interna, Rome, Italy
| | - G Walter Canonica
- Personalized Medicine Asthma & Allergy Clinic-Humanitas University & Research Hospital, IRCCS, Milan, Italy
| | - Juliet M Foster
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, Netherlands
| | | | | | | | | | | | - Fulvio Braido
- Department of Internal Medicine, University of Genova, Genova, Italy
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Drummond D. Outils connectés pour la télésurveillance des patients asthmatiques : gadgets ou révolution? Rev Mal Respir 2022; 39:241-257. [DOI: 10.1016/j.rmr.2022.01.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 01/07/2022] [Indexed: 11/28/2022]
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Vaccari I, Orani V, Paglialonga A, Cambiaso E, Mongelli M. A Generative Adversarial Network (GAN) Technique for Internet of Medical Things Data. SENSORS (BASEL, SWITZERLAND) 2021; 21:3726. [PMID: 34071944 PMCID: PMC8197837 DOI: 10.3390/s21113726] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Revised: 05/18/2021] [Accepted: 05/25/2021] [Indexed: 11/16/2022]
Abstract
The application of machine learning and artificial intelligence techniques in the medical world is growing, with a range of purposes: from the identification and prediction of possible diseases to patient monitoring and clinical decision support systems. Furthermore, the widespread use of remote monitoring medical devices, under the umbrella of the "Internet of Medical Things" (IoMT), has simplified the retrieval of patient information as they allow continuous monitoring and direct access to data by healthcare providers. However, due to possible issues in real-world settings, such as loss of connectivity, irregular use, misuse, or poor adherence to a monitoring program, the data collected might not be sufficient to implement accurate algorithms. For this reason, data augmentation techniques can be used to create synthetic datasets sufficiently large to train machine learning models. In this work, we apply the concept of generative adversarial networks (GANs) to perform a data augmentation from patient data obtained through IoMT sensors for Chronic Obstructive Pulmonary Disease (COPD) monitoring. We also apply an explainable AI algorithm to demonstrate the accuracy of the synthetic data by comparing it to the real data recorded by the sensors. The results obtained demonstrate how synthetic datasets created through a well-structured GAN are comparable with a real dataset, as validated by a novel approach based on machine learning.
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Affiliation(s)
- Ivan Vaccari
- Consiglio Nazionale delle Ricerche (CNR), Institute of Electronics, Information Engineering and Telecommunications (IEIIT), 16149 Genoa, Italy; (V.O.); (E.C.); (M.M.)
| | - Vanessa Orani
- Consiglio Nazionale delle Ricerche (CNR), Institute of Electronics, Information Engineering and Telecommunications (IEIIT), 16149 Genoa, Italy; (V.O.); (E.C.); (M.M.)
| | - Alessia Paglialonga
- Consiglio Nazionale delle Ricerche (CNR), Institute of Electronics, Information Engineering and Telecommunications (IEIIT), 20133 Milan, Italy;
| | - Enrico Cambiaso
- Consiglio Nazionale delle Ricerche (CNR), Institute of Electronics, Information Engineering and Telecommunications (IEIIT), 16149 Genoa, Italy; (V.O.); (E.C.); (M.M.)
| | - Maurizio Mongelli
- Consiglio Nazionale delle Ricerche (CNR), Institute of Electronics, Information Engineering and Telecommunications (IEIIT), 16149 Genoa, Italy; (V.O.); (E.C.); (M.M.)
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Mosnaim G, Safioti G, Brown R, DePietro M, Szefler SJ, Lang DM, Portnoy JM, Bukstein DA, Bacharier LB, Merchant RK. Digital Health Technology in Asthma: A Comprehensive Scoping Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2021; 9:2377-2398. [PMID: 33652136 DOI: 10.1016/j.jaip.2021.02.028] [Citation(s) in RCA: 41] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 12/18/2022]
Abstract
BACKGROUND A variety of digital intervention approaches have been investigated for asthma therapy during the past decade, with different levels of interactivity and personalization and a range of impacts on different outcome measurements. OBJECTIVE To assess the effectiveness of digital interventions in asthma with regard to acceptability and outcomes and evaluate the potential of digital initiatives for monitoring or treating patients with asthma. METHODS We evaluated digital interventions using a scoping review methodology through a literature search and review. Of 871 articles identified, 121 were evaluated to explore intervention characteristics, the perception and acceptability of digital interventions to patients and physicians, and effects on asthma outcomes. Interventions were categorized by their level of interactivity with the patient. RESULTS Interventions featuring non-individualized content sent to patients appeared capable of promoting improved adherence to inhaled corticosteroids, but with no identified improvement in asthma burden; and data-gathering interventions appeared to have little effect on adherence or asthma burden. Evidence of improvement in both adherence and patients' impairment due to asthma were seen only with interactive interventions involving two-way responsive patient communication. Digital interventions were generally positively perceived by patients and physicians. Implementation was considered feasible, with certain preferences for design and features important to drive use. CONCLUSIONS Digital health interventions show substantial promise for asthma disease monitoring and personalization of treatment. To be successful, future interventions will need to include both inhaler device and software elements, combining accurate measurement of clinical parameters with careful consideration of ease of use, personalization, and patient engagement aspects.
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Affiliation(s)
- Giselle Mosnaim
- Division of Pulmonary, Allergy and Critical Care, Department of Medicine, North Shore University Health System, Evanston, Ill
| | | | - Randall Brown
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa
| | - Michael DePietro
- Teva Branded Pharmaceutical Products R&D, Inc, West Chester, Pa.
| | - Stanley J Szefler
- The Breathing Institute and Pulmonary Medicine Section, Children's Hospital Colorado and University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, Colo
| | - David M Lang
- Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic, Cleveland, Ohio
| | - Jay M Portnoy
- Pediatric Allergy and Immunology, Children's Mercy Hospital, Kansas City School of Medicine, Kansas City, Mo
| | - Don A Bukstein
- Allergy, Asthma and Sinus Center, Milwaukee, Greenfield, Wis
| | - Leonard B Bacharier
- Department of Pediatrics, Monroe Carell Jr Children's Hospital at Vanderbilt University Medical Center, Nashville, Tenn
| | - Rajan K Merchant
- Woodland Clinic Medical Group, Allergy Department, Dignity Health, Woodland, Calif
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9
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Bousquet J, Anto JM, Bachert C, Haahtela T, Zuberbier T, Czarlewski W, Bedbrook A, Bosnic-Anticevich S, Walter Canonica G, Cardona V, Costa E, Cruz AA, Erhola M, Fokkens WJ, Fonseca JA, Illario M, Ivancevich JC, Jutel M, Klimek L, Kuna P, Kvedariene V, Le L, Larenas-Linnemann DE, Laune D, Lourenço OM, Melén E, Mullol J, Niedoszytko M, Odemyr M, Okamoto Y, Papadopoulos NG, Patella V, Pfaar O, Pham-Thi N, Rolland C, Samolinski B, Sheikh A, Sofiev M, Suppli Ulrik C, Todo-Bom A, Tomazic PV, Toppila-Salmi S, Tsiligianni I, Valiulis A, Valovirta E, Ventura MT, Walker S, Williams S, Yorgancioglu A, Agache I, Akdis CA, Almeida R, Ansotegui IJ, Annesi-Maesano I, Arnavielhe S, Basagaña X, D Bateman E, Bédard A, Bedolla-Barajas M, Becker S, Bennoor KS, Benveniste S, Bergmann KC, Bewick M, Bialek S, E Billo N, Bindslev-Jensen C, Bjermer L, Blain H, Bonini M, Bonniaud P, Bosse I, Bouchard J, Boulet LP, Bourret R, Boussery K, Braido F, Briedis V, Briggs A, Brightling CE, Brozek J, Brusselle G, Brussino L, Buhl R, Buonaiuto R, Calderon MA, Camargos P, Camuzat T, Caraballo L, Carriazo AM, Carr W, Cartier C, Casale T, Cecchi L, Cepeda Sarabia AM, H Chavannes N, Chkhartishvili E, Chu DK, Cingi C, Correia de Sousa J, Costa DJ, Courbis AL, Custovic A, Cvetkosvki B, D'Amato G, da Silva J, Dantas C, Dokic D, Dauvilliers Y, De Feo G, De Vries G, Devillier P, Di Capua S, Dray G, Dubakiene R, Durham SR, Dykewicz M, Ebisawa M, Gaga M, El-Gamal Y, Heffler E, Emuzyte R, Farrell J, Fauquert JL, Fiocchi A, Fink-Wagner A, Fontaine JF, Fuentes Perez JM, Gemicioğlu B, Gamkrelidze A, Garcia-Aymerich J, Gevaert P, Gomez RM, González Diaz S, Gotua M, Guldemond NA, Guzmán MA, Hajjam J, Huerta Villalobos YR, Humbert M, Iaccarino G, Ierodiakonou D, Iinuma T, Jassem E, Joos G, Jung KS, Kaidashev I, Kalayci O, Kardas P, Keil T, Khaitov M, Khaltaev N, Kleine-Tebbe J, Kouznetsov R, Kowalski ML, Kritikos V, Kull I, La Grutta S, Leonardini L, Ljungberg H, Lieberman P, Lipworth B, Lodrup Carlsen KC, Lopes-Pereira C, Loureiro CC, Louis R, Mair A, Mahboub B, Makris M, Malva J, Manning P, Marshall GD, Masjedi MR, Maspero JF, Carreiro-Martins P, Makela M, Mathieu-Dupas E, Maurer M, De Manuel Keenoy E, Melo-Gomes E, Meltzer EO, Menditto E, Mercier J, Micheli Y, Miculinic N, Mihaltan F, Milenkovic B, Mitsias DI, Moda G, Mogica-Martinez MD, Mohammad Y, Montefort S, Monti R, Morais-Almeida M, Mösges R, Münter L, Muraro A, Murray R, Naclerio R, Napoli L, Namazova-Baranova L, Neffen H, Nekam K, Neou A, Nordlund B, Novellino E, Nyembue D, O'Hehir R, Ohta K, Okubo K, Onorato GL, Orlando V, Ouedraogo S, Palamarchuk J, Pali-Schöll I, Panzner P, Park HS, Passalacqua G, Pépin JL, Paulino E, Pawankar R, Phillips J, Picard R, Pinnock H, Plavec D, Popov TA, Portejoie F, Price D, Prokopakis EP, Psarros F, Pugin B, Puggioni F, Quinones-Delgado P, Raciborski F, Rajabian-Söderlund R, Regateiro FS, Reitsma S, Rivero-Yeverino D, Roberts G, Roche N, Rodriguez-Zagal E, Rolland C, Roller-Wirnsberger RE, Rosario N, Romano A, Rottem M, Ryan D, Salimäki J, Sanchez-Borges MM, Sastre J, Scadding GK, Scheire S, Schmid-Grendelmeier P, Schünemann HJ, Sarquis Serpa F, Shamji M, Sisul JC, Sofiev M, Solé D, Somekh D, Sooronbaev T, Sova M, Spertini F, Spranger O, Stellato C, Stelmach R, Thibaudon M, To T, Toumi M, Usmani O, Valero AA, Valenta R, Valentin-Rostan M, Pereira MU, van der Kleij R, Van Eerd M, Vandenplas O, Vasankari T, Vaz Carneiro A, Vezzani G, Viart F, Viegi G, Wallace D, Wagenmann M, Wang DY, Waserman S, Wickman M, Williams DM, Wong G, Wroczynski P, Yiallouros PK, Yusuf OM, Zar HJ, Zeng S, Zernotti ME, Zhang L, Shan Zhong N, Zidarn M. ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice. Allergy 2020; 76:168-190. [PMID: 32512619 DOI: 10.1111/all.14422] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 05/04/2020] [Accepted: 05/19/2020] [Indexed: 12/12/2022]
Abstract
Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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Affiliation(s)
- Jean Bousquet
- MACVIA-France and CHU, Montpellier, France.,INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif, Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny le Bretonneux, France, and Charité, Universitätsmedizin Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Comprehensive Allergy Center, Department of Dermatology and Allergy, Berlin, Germany
| | - Josep M Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium and Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital Guangzou, China, and Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm and Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany
| | | | | | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - G Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d'Hebron & ARADyAL research network, Barcelona, Spain
| | - Elisio Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A Cruz
- ProAR-Nucleo de Excelencia em Asma, Federal University of Bahia, Brasil and WHO GARD Planning Group, Brazil
| | - Marina Erhola
- National Insitute for Health and Welfare, Helsinki, Finland
| | - Wytske J Fokkens
- Department of Otorhinolaryngology, Academic Medical Centres, AMC, Amsterdam, the Netherlands, and Euforea, Brussels, Belgium
| | - Joao A Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto; and Medida, Lda Porto, Portugal
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R&D and DISMET), Naples, Italy
| | | | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University and ALL-MED Medical Research Institute, Warsaw, Poland
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Poland
| | - Violeta Kvedariene
- Institute of Biomedical Sciences, Department of Pathology, Faculty of Medicine, Vilnius University and Institute of Clinical Medicine, Clinic of Chest diseases and Allergology, Faculty of Medicine, Vilnius, Lithuania
| | - Ltt Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - Désirée E Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Olga M Lourenço
- Faculty of Health Sciences and CICS-UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | - Erik Melén
- Sachs' Children and Youth Hospital, Södersjukhuset, Stockholm and Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic; Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Spain
| | - Marek Niedoszytko
- Department of Allergology, Medical University of Gdańsk, Gdańsk, Poland
| | - Mikaëla Odemyr
- EFA European Federation of Allergy and Airways Diseases Patients' Associations, Brussels, Belgium
| | - Yoshitaka Okamoto
- Dept of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - Nikos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children's Hospital, University of Manchester, Manchester, UK.,Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - Vincenzo Patella
- Division of Allergy and Clinical Immunology, Department of Medicine, Agency of Health ASL Salerno, "Santa Maria della Speranza" Hospital, Salerno, Italy
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | - Nhân Pham-Thi
- Ecole polytechnique, Palaiseau, IRBA (Institut de Recherche bio-Médicale des Armées, Bretigny), France
| | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Mikhail Sofiev
- Finnish Meteorological Institute (FMI), Helsinki, Finland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital & University of Copenhagen, Copenhagen, Denmark
| | - Ana Todo-Bom
- Allergy and Clinical Immunology Unit, Institute of Immunology, Faculty of Medicine, University of Coimbra, ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Coimbra, Portugal
| | | | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece and International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - Arunas Valiulis
- Vilnius University Faculty of Medicine, Institute of Clinical Medicine & Institute of Health Sciences, Vilnius, Lithuania
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Maria-Teresa Ventura
- University of Bari Medical School, Unit of Geriatric Immunoallergology, Bari, Italy
| | | | - Sian Williams
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Cezmi A Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Rute Almeida
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto; and Medida, Lda Porto, Portugal
| | - Ignacio J Ansotegui
- Department of Allergy and Immunology, Hospital Quirón Bizkaia, Erandio, Spain
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Universités, Medical School Saint Antoine, Paris, France
| | | | - Xavier Basagaña
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Eric D Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Annabelle Bédard
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain.,IMIM (Hospital del Mar Research Institute), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain.,Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - Sven Becker
- Department of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
| | - Kazi S Bennoor
- Dept of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France.,Mines ParisTech CRI-PSL Research University, Fontainebleau, France
| | - Karl C Bergmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany
| | | | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with the Division of Laboratory Medicine, Warsaw Medical University, Warsaw, Poland
| | | | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital, Montpellier, France.,EA 2991, Euromov, University Montpellier, Montpellier, France
| | - Matteo Bonini
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy, and National Heart and Lung Institute, Royal Brompton Hospital & Imperial College London, London, UK
| | | | | | | | | | | | - Koen Boussery
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | - Fluvio Braido
- University of Genoa, Department of Internal Medicine (DiMI) and IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian, University of Health, Kaunas, Lithuania
| | - Andrew Briggs
- Health Economics and Health Technology Assessment, Institute of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Christopher E Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK; Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Jan Brozek
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Guy Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Luisa Brussino
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | - Roland Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Moises A Calderon
- Imperial College London-National Heart and Lung Institute, London, UK
| | - Paulo Camargos
- Department of Pediatrics, Medical School, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Thierry Camuzat
- Assitant Director General, Montpellier, Région Occitanie, Montpellier, France
| | - Luis Caraballo
- Institute for Immunological Research, University of Cartagena, Campus de Zaragocilla, Edificio Biblioteca Primer Piso, Cartagena, Colombia, and Foundation for the Development of Medical and Biological Sciences (Fundemeb), Cartagena, Colombia
| | | | - Warner Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA, USA
| | | | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL, USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Alfonso M Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia and SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Branquilla, Colombia
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Ekaterine Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - Derek K Chu
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Cemal Cingi
- ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal; ICVS/3B's, PT Government Associate Laboratory, Guimaraes, Portugal
| | | | | | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - Biljana Cvetkosvki
- Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Gennaro D'Amato
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Specialty Hospital ACardarelli, Napoli, Italy
| | - Jane da Silva
- Department of Internal Medicine and Allergy Clinic of Professor Polydoro Ernani de São, Thiago University Hospital, Federal University of Santa Catarina (UFSC), Florianopolis-SC, Brazil
| | - Carina Dantas
- Cáritas Diocesana de Coimbra, Coimbra, Portugal, Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - Dejan Dokic
- Medical Faculty Skopje, University Clinic of Pulmology and Allergy, Skopje, Republic of Macedonia
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hôpital Gui-de-Chauliac Montpellier, Inserm U1061, Montpellier, France
| | - Giulia De Feo
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | | | - Philippe Devillier
- UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | | | - Gerard Dray
- IMT Mines Ales, Université Montpellier, Montpellier, France
| | - Ruta Dubakiene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - Stephen R Durham
- Allergy and Clinical Immunology Section, National Heart and Lung Institute, Imperial College London, London, UK
| | - Mark Dykewicz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO, USA
| | - Motohiro Ebisawa
- Clinical Research Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - Mina Gaga
- ERS President 2017-2018, Athens Chest Hospital, 7th Resp Med Dept and Asthma Center, Athens, Greece
| | - Yehia El-Gamal
- Pediatric Allergy and Immunology Unit, Children's hospital, Ain Shams University, Cairo, Egypt
| | - Enrico Heffler
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Regina Emuzyte
- Clinic of Children's Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - John Farrell
- Department of Health, Social Services and Public Safety, Northern Ireland Belfast, UK
| | - Jean-Luc Fauquert
- CHU Clermont-Ferrand, Unité d'allergologie de l'enfant, pôle pédiatrique, Hôpital Estaing, Clermont-Ferrand, France
| | - Alessandro Fiocchi
- Division of Allergy, Department of Pediatric Medicine-The Bambino Gesù Children's Research Hospital Holy See, Rome, Italy
| | | | | | - José M Fuentes Perez
- Hospital General Regional 1 "Dr Carlos Mc Gregor Sanchez Navarro" IMSS, Mexico City, Mexico
| | - Bilun Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istanbul, Turkey
| | - Amiran Gamkrelidze
- Gamkrelidze National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Philippe Gevaert
- Upper Airways Research Laboratory, ENT Department, Ghent University Hospital, Ghent, Belgium and Sun Yat-sen University, International Airway Research Center, First Affiliated Hospital Guangzou, China, and Division of ENT Diseases, CLINTEC, Karolinska Institutet, Stockholm and Department of ENT Diseases, Karolinska University Hospital, Stockholm, Sweden
| | | | | | - Maia Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
| | - Nick A Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | - Maria-Antonieta Guzmán
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - Jawad Hajjam
- Centich: Centre d'Expertise National des Technologies de l'Information et de la communication pour l'autonomie, Groupe VyV, Conseil Régional des Pays de la Loire, Centre d'expertise PartenariatEuropéen d'Innovation pour un vieillissement actif et en bonne santé, Nantes, France
| | | | - Marc Humbert
- Université Paris-Sud; Service de Pneumologie, Hôpital Bicêtre; Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - Guido Iaccarino
- Department of Advanced Biomedical Sciences, Federico II University, Napoli, Italy
| | - Despo Ierodiakonou
- Department of Social Medicine, Faculty of Medicine, University of Crete, and International Primary Care Respiratory Group, Crete, Greece
| | - Tomohisa Iinuma
- Dept of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - Ewa Jassem
- Department of Allergology, Medical University of Gdańsk, Gdansk, Poland
| | - Guy Joos
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Ki-Suck Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Gyeonggi-do, South Korea
| | - Igor Kaidashev
- Ukrainina Medical Stomatological Academy, Poltava, Ukraine
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz, Poland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, and Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, and Institute of Health Resort Medicine and Health Promotion, Bavarian Health and Food Safety Authority, Bad Kissingen, Germany
| | - Musa Khaitov
- National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular immunology, Moscow, Russian Federation
| | | | | | | | - Marek L Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Lodz, Poland
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney and Woolcock Emphysema Centre and Sydney Local Health District, Glebe, NSW, Australia
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, and Sach's Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | - Stefania La Grutta
- Institute for Research and Biomedical Innovation (IRIB), National Research Council (CNR), Palermo, Italy
| | - Lisa Leonardini
- Veneto Region, Mattone Internazionale Program, Venise, Italy
| | - Henrik Ljungberg
- Lung-Allergy Department at Astrid Lindgren Children's Hospital, Karolinska University Hospital, & Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Philip Lieberman
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, TN, USA
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Karin C Lodrup Carlsen
- Oslo University Hospital, Department of Paediatrics, Oslo, and University of Oslo, Faculty of Medicine, Institute of Clinical Medicine, Oslo, Norway
| | | | - Claudia C Loureiro
- Pneumology Department, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
| | - Alpana Mair
- DG for Health and Social Care, Scottish Government, Edinburgh, UK
| | - Bassam Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - Michaël Makris
- Allergy Unit "D Kalogeromitros", 2nd Department of Dermatology and Venereology, National & Kapodistrian University of Athens, "Attikon" University Hospital, Chaidari, Greece
| | - Joao Malva
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra; Coimbra, and Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - Patrick Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | - Gailen D Marshall
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS, USA
| | - Mohamed R Masjedi
- Tobacco Control Research Centre; Iranian Anti Tobacco Association, Tehran, Iran
| | - Jorge F Maspero
- Argentine Association of Allergy and Clinical Immunology, Buenos Aires, Argentina
| | - Pedro Carreiro-Martins
- Serviço de Immunologia, Hospital de Dona Estefânia, Centro Hospitalar de Lisboa Central, Lisbon, Portugal and Nova Medical School/Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Mika Makela
- Skin and Allergy Hospital, Helsinki University Hospital, and University of Helsinki, Helsinki, Finland
| | | | - Marcus Maurer
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany
| | | | - Elisabete Melo-Gomes
- PNDR, Portuguese National Programme for Respiratory Diseases, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Eli O Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA, USA
| | | | - Jacques Mercier
- Department of Physiology, CHRU, University Montpellier, Vice President for Research, PhyMedExp, INSERM U1046, CNRS UMR 9214, Montpellier, France
| | | | | | - Florin Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbian Association for Asthma and COPD, Belgrade, Serbia
| | - Dimitirios I Mitsias
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | | | | | - Yousser Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, and Syrian Private University-Damascus, Damascus, Syria
| | - Steve Montefort
- Lead Respiratory Physician Mater Dei Hospital Malta, Academic Head of Department and Professor of Medicine, University of Malta, Deputy Dean Faculty of Medicine and Surgery, University of Medicine, La Valette, Malta
| | - Ricardo Monti
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Torino, Italy
| | | | - Ralph Mösges
- CRI-Clinical Research International-Ltd, Hamburg, Germany
| | - Lars Münter
- Danish Committee for Health Education, Copenhagen East, Denmark
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Ruth Murray
- Research Fellow, OPC, Cambridge, UK and Director Medscript, Paraparaumu, New Zealand
| | | | - Luigi Napoli
- Director, Consortium of Pharmacies and Services COSAFER, Salerno, Italy
| | - Leyla Namazova-Baranova
- Scientific Centre of Children's Health under the PoH, Russian National Research Medical University named Pirogov, Moscow, Russia
| | - Hugo Neffen
- Director of Center of Allergy, Immunology and Respiratory Diseases, Center for Allergy and Immunology, Santa Fe, Argentina
| | - Kristoff Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - Angelo Neou
- Die Hautambulanz and Rothhaar study center, Berlin, Germany
| | - Björn Nordlund
- Lung-Allergy Department at Astrid Lindgren Children's Hospital, Karolinska University Hospital, & Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Ettore Novellino
- Director of Department of Pharmacy of University of Naples Federico II, Naples, Italy
| | | | - Robyn O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, Vic., Australia; Department of Immunology, Monash University, Melbourne, Vic., Australia
| | - Ken Ohta
- Allergy Department, 2nd Pediatric Clinic, Athens General Children's Hospital "P&A Kyriakou", University of Athens, Athens, Greece
| | - Kimi Okubo
- Department of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | | | - Valentina Orlando
- Director of Department of Pharmacy of University of Naples Federico II, Naples, Italy
| | - Solange Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | | | - Isabella Pali-Schöll
- Department of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine and Medical University, Vienna, Austria
| | - Peter Panzner
- Department of Immunology and Allergology, Faculty of Medicine in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Gianni Passalacqua
- Allergy and Respiratory Diseases, Ospedale Policlino San Martino-University of Genoa, Genoa, Italy
| | - Jean-Louis Pépin
- Université Grenoble Alpes, Laboratoire HP2, Grenoble, INSERM, U1042 and CHU de Grenoble, Grenoble, France
| | | | - Ruby Pawankar
- Department of Pediatrics, Nippon Medical School, Tokyo, Japan
| | - Jim Phillips
- Centre for Empowering Patients and Communities, Faulkland, UK
| | - Robert Picard
- Conseil Général de l'Economie Ministère de l'Economie, de l'Industrie et du Numérique, Paris, France
| | - Hilary Pinnock
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Davor Plavec
- Children's Hospital Srebrnjak, Zagreb, School of Medicine, University JJ Strossmayer, Osijek, Croatia
| | - Todor A Popov
- University Hospital "Sv Ivan Rilski", Sofia, Bulgaria
| | | | - David Price
- Observational and Pragmatic Research Institute Singapore, Singapore City, Singapore
| | - Emmanuel P Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - Fotis Psarros
- Allergy Department, Athens Naval Hospital, Athens, Greece
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Francesca Puggioni
- Personalized Medicine Clinic Asthma & Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano and Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Pablo Quinones-Delgado
- Agency for Social Services and Dependency, Regional Government for Equality, Social Policies and Conciliation of Andalucia, Seville, Spain
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Frederico S Regateiro
- Allergy and Clinical Immunology Unit, Institute of Immunology, Faculty of Medicine, University of Coimbra, ICBR - Coimbra Institute for Clinical and Biomedical Research, CIBB, Coimbra, Portugal
| | - Sietze Reitsma
- Department of Otorhinolaryngology, Academic Medical Centres, AMC, Amsterdam, the Netherlands, and Euforea, Brussels, Belgium
| | | | - Graham Roberts
- David Hide Centre, St Mary's Hospital, Isle of Wight and University of Southampton, Southampton, UK
| | - Nicolas Roche
- Pneumologie et Soins Intensifs Respiratoires, Centre Hôpital Cochin, Hôpitaux Universitaires Paris, Paris, France
| | | | | | | | - Nelson Rosario
- Hospital de Clinicas, University of Parana, Parana, Brazil
| | - Antonino Romano
- Allergy Unit, Presidio Columbus, Rome, Catholic University of Sacred Heart, Rome and IRCCS Oasi Maria SS, Troina, Italy
| | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - Dermot Ryan
- Honorary Clinical Research Fellow, Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | | | - Mario M Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Joaquin Sastre
- Faculty of Medicine, Autnonous University of Madrid, Madrid, Spain
| | | | - Sophie Scheire
- Pharmaceutical Care Unit, Faculty of Pharmaceutical Sciences, Ghent University, Ghent, Belgium
| | | | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, Division of Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Faradiba Sarquis Serpa
- Asthma Reference Center, School of Medicine of Santa Casa de Misericordia of Vitoria-Esperito Santo, Vitoria, Brazil
| | - Mohamed Shamji
- Immunomodulation and Tolerance Group, Imperial College London, and Allergy and Clinical Immunology, Imperial College London, London, UK
| | | | - Mikhail Sofiev
- Finnish Meteorological Institute (FMI), Helsinki, Finland
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, Sao Paulo, Brazil
| | - David Somekh
- European Health Futures Forum (EHFF), Dromahair, UK
| | - Talant Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - Milan Sova
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - François Spertini
- Service Immunologie et Allergie, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland
| | - Otto Spranger
- Global Allergy and Airways Patient Platform GAAPP, Vienna, Austria
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, Salerno, Italy
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Michel Thibaudon
- RNSA (Réseau National de Surveillance Aérobiologique), Brussieu, France
| | - Teresa To
- Sidkkids Hospitala and Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Mondher Toumi
- Public Health, Aix-marseille University, Marseille, France
| | - Omar Usmani
- National Heart and Lung Institute (NHLI), Imperial College London & Royal Brompton Hospital, Airways Disease Section, London, UK
| | - Antonio A Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rudolph Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria.,NRC Institute of Immunology FMBA of Russia, Moscow, Russia and Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | | | - Rianne van der Kleij
- Department of Public Health & Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands, Erasmus MC, Department of Obstetrics and Gynaecology, University Medical Center, Rotterdam, The Netherlands
| | | | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Tuula Vasankari
- FILHA, Finnish Lung Association, Helsinki, and Turku University, Turku, Finland
| | - Antonio Vaz Carneiro
- Instituto de Medicina Preventiva e Saude Publica, Instituto de Saude Ambiental, Centro de Estudos de Medicina Baseada na Evidência, Cochrane, Portugal
| | - Giorgio Vezzani
- Pulmonary Unit, Department of Medical Specialties, Arcispedale SMaria Nuova/IRCCS, AUSL di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa (Italy), Via Trieste 41, 56126, Pisa, Italy; and CNR Institute of Biomedicine and Molecular Immunology "A Monroy", Palermo, Italy
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, FL, USA
| | - Martin Wagenmann
- Department of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - De Yun Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore City, Singapore
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON, Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Dennis M Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA
| | - Gary Wong
- Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, China
| | - Piotr Wroczynski
- Department of Physical Pharmacy and Bioanalysis, Faculty of Pharmacy with the Laboratory Medicine Division, Medical University of Warsaw, Warsaw, Poland
| | - Panayiotis K Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus; Department of Pediatrics, Hospital "Archbishop Makarios III", Nicosia, Cyprus
| | | | - Heather J Zar
- Department of Paediatrics and Child Health, Red Cross Children's Hospital, and MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - Nan Shan Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
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Larsson K, Kankaanranta H, Janson C, Lehtimäki L, Ställberg B, Løkke A, Høines K, Roslind K, Ulrik CS. Bringing asthma care into the twenty-first century. NPJ Prim Care Respir Med 2020; 30:25. [PMID: 32503985 PMCID: PMC7275071 DOI: 10.1038/s41533-020-0182-2] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 04/21/2020] [Indexed: 12/16/2022] Open
Abstract
Despite access to diagnostic tests and effective therapies, asthma often remains misdiagnosed and/or poorly controlled or uncontrolled. In this review, we address the key issues of asthma diagnosis and management, recent evidence for levels of asthma control, the consequences of poor control and, in line with that, explore the potential reasons for poor asthma control and acute exacerbations. Based on recent evidence and current guidelines, we also aim to provide practical answers to the key questions of how to improve asthma management, with the best possible prevention of exacerbations, addressing the basics-adherence, inhaler misuse, obesity and smoking-and how to facilitate a new era of asthma care in the twenty-first century. We hope this review will be useful to busy primary care clinicians in their future interactions with their patients with both suspected and proven asthma.
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Affiliation(s)
- Kjell Larsson
- Integrative Toxicology, National Institute of Environmental Medicine, IMM, Karolinska Institute, Stockholm, Sweden.
| | - Hannu Kankaanranta
- Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
| | - Christer Janson
- Department of Medical Sciences: Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden
| | - Lauri Lehtimäki
- Faculty of Medicine and Health Technology, University of Tampere, Tampere, Finland
- Allergy Centre, Tampere University Hospital, Tampere, Finland
| | - Björn Ställberg
- Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden
| | - Anders Løkke
- Department of Medicine, Little Belt Hospital, Vejle, Denmark
| | | | | | - Charlotte Suppli Ulrik
- Respiratory Research Unit Hvidovre, Department of Respiratory Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
- Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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11
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Bousquet JJ, Schünemann HJ, Togias A, Erhola M, Hellings PW, Zuberbier T, Agache I, Ansotegui IJ, Anto JM, Bachert C, Becker S, Bedolla-Barajas M, Bewick M, Bosnic-Anticevich S, Bosse I, Boulet LP, Bourrez JM, Brusselle G, Chavannes N, Costa E, Cruz AA, Czarlewski W, Fokkens WJ, Fonseca JA, Gaga M, Haahtela T, Illario M, Klimek L, Kuna P, Kvedariene V, Le LTT, Larenas-Linnemann D, Laune D, Lourenço OM, Menditto E, Mullol J, Okamoto Y, Papadopoulos N, Pham-Thi N, Picard R, Pinnock H, Roche N, Roller-Wirnsberger RE, Rolland C, Samolinski B, Sheikh A, Toppila-Salmi S, Tsiligianni I, Valiulis A, Valovirta E, Vasankari T, Ventura MT, Walker S, Williams S, Akdis CA, Annesi-Maesano I, Arnavielhe S, Basagana X, Bateman E, Bedbrook A, Bennoor KS, Benveniste S, Bergmann KC, Bialek S, Billo N, Bindslev-Jensen C, Bjermer L, Blain H, Bonini M, Bonniaud P, Bouchard J, Briedis V, Brightling CE, Brozek J, Buhl R, Buonaiuto R, Canonica GW, Cardona V, Carriazo AM, Carr W, Cartier C, Casale T, Cecchi L, Cepeda Sarabia AM, Chkhartishvili E, Chu DK, Cingi C, Colgan E, de Sousa JC, Courbis AL, Custovic A, Cvetkosvki B, D’Amato G, da Silva J, Dantas C, Dokic D, Dauvilliers Y, Dedeu A, De Feo G, Devillier P, Di Capua S, Dykewickz M, Dubakiene R, Ebisawa M, El-Gamal Y, Eller E, Emuzyte R, Farrell J, Fink-Wagner A, Fiocchi A, Fontaine JF, Gemicioğlu B, Schmid-Grendelmeir P, Gamkrelidze A, Garcia-Aymerich J, Gomez M, González Diaz S, Gotua M, Guldemond NA, Guzmán MA, Hajjam J, O’B Hourihane J, Humbert M, Iaccarino G, Ierodiakonou D, Illario M, Ivancevich JC, Joos G, Jung KS, Jutel M, Kaidashev I, Kalayci O, Kardas P, Keil T, Khaitov M, Khaltaev N, Kleine-Tebbe J, Kowalski ML, Kritikos V, Kull I, Leonardini L, Lieberman P, Lipworth B, Lodrup Carlsen KC, Loureiro CC, Louis R, Mair A, Marien G, Mahboub B, Malva J, Manning P, De Manuel Keenoy E, Marshall GD, Masjedi MR, Maspero JF, Mathieu-Dupas E, Matricardi PM, Melén E, Melo-Gomes E, Meltzer EO, Menditto E, Mercier J, Miculinic N, Mihaltan F, Milenkovic B, Moda G, Mogica-Martinez MD, Mohammad Y, Montefort S, Monti R, Morais-Almeida M, Mösges R, Münter L, Muraro A, Murray R, Naclerio R, Napoli L, Namazova-Baranova L, Neffen H, Nekam K, Neou A, Novellino E, Nyembue D, O’Hehir R, Ohta K, Okubo K, Onorato G, Ouedraogo S, Pali-Schöll I, Palkonen S, Panzner P, Park HS, Pépin JL, Pereira AM, Pfaar O, Paulino E, Phillips J, Picard R, Plavec D, Popov TA, Portejoie F, Price D, Prokopakis EP, Pugin B, Raciborski F, Rajabian-Söderlund R, Reitsma S, Rodo X, Romano A, Rosario N, Rottem M, Ryan D, Salimäki J, Sanchez-Borges MM, Sisul JC, Solé D, Somekh D, Sooronbaev T, Sova M, Spranger O, Stellato C, Stelmach R, Suppli Ulrik C, Thibaudon M, To T, Todo-Bom A, Tomazic PV, Valero AA, Valenta R, Valentin-Rostan M, van der Kleij R, Vandenplas O, Vezzani G, Viart F, Viegi G, Wallace D, Wagenmann M, Wang DY, Waserman S, Wickman M, Williams DM, Wong G, Wroczynski P, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zeng S, Zernotti M, Zhang L, Zhong NS, Zidarn M. Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases. Clin Transl Allergy 2019; 9:44. [PMID: 31516692 PMCID: PMC6734297 DOI: 10.1186/s13601-019-0279-2] [Citation(s) in RCA: 61] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/29/2019] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy. MAIN BODY As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care. CONCLUSION In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
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Affiliation(s)
- J. Jean Bousquet
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU, 34295 Montpellier Cedex 5, France
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny Le Bretonneux, France
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin, Germany
| | - Holger J. Schünemann
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Alkis Togias
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
| | - Marina Erhola
- National Institute for Health and Welfare, Helsinki, Finland
| | - Peter W. Hellings
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Dept of Otorhinolaryngology, Univ Hospitals Leuven, Louvain, Belgium
- Academic Medical Center, Univ of Amsterdam, Amsterdam, The Netherlands
| | - Torsten Zuberbier
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy Member of GA2LEN, Comprehensive Allergy-Centre, Berlin Institute of Health, Berlin, Germany
| | - Ioana Agache
- Faculty of Medicine, Transylvania University, Brasov, Romania
| | - Ignacio J. Ansotegui
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
| | - Josep M. Anto
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Claus Bachert
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
| | - Sven Becker
- Dept of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
| | | | | | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Woolcock Emphysema Centre, Sydney, Australia
- Sydney Local Health District, Glebe, NSW Australia
| | | | - Louis P. Boulet
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC Canada
| | | | - Guy Brusselle
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
| | - Niels Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Elisio Costa
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
| | - Alvaro A. Cruz
- ProAR–Nucleo de Excelencia em Asma, Federal University of Bahia, Bahia, Brazil
- WHO GARD Planning Group, Salvador, Brazil
| | | | - Wytske J. Fokkens
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Joao A. Fonseca
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Medida, Lda Porto, Portugal
| | - Mina Gaga
- ERS President 2017-2018, Athens Chest Hospital, 7th Resp Med Dept and Asthma Center, Athens, Greece
| | - Tari Haahtela
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Maddalena Illario
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R &D and DISMET), Naples, Italy
| | - Ludger Klimek
- Center for Rhinology and Allergology, Wiesbaden, Germany
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Łódź, Poland
| | | | - L. T. T. Le
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
| | - Desiree Larenas-Linnemann
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
| | | | - Olga M. Lourenço
- Faculty of Health Sciences and CICS–UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
| | | | - Joaquin Mullol
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
| | - Yashitaka Okamoto
- Dept of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
| | - Nikos Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children’s Hospital, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital “P&A Kyriakou”, University of Athens, Athens, Greece
| | - Nhân Pham-Thi
- Allergy Department, Pasteur Institute, Paris, France
| | - Robert Picard
- Conseil Général de l’Economie Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
| | - Hilary Pinnock
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Nicolas Roche
- Pneumologie et Soins Intensifs Respiratoires, Hôpitaux Universitaires Paris, Centre Hôpital Cochin, Paris, France
| | | | | | - Boleslaw Samolinski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Sanna Toppila-Salmi
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
| | - Ioanna Tsiligianni
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland UK
| | - Arunas Valiulis
- Institute of Clinical Medicine & Institute of Health Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
| | - Erkka Valovirta
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | | | - Maria-Teresa Ventura
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
| | | | - Sian Williams
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | - Cezmi A. Akdis
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
| | - Isabella Annesi-Maesano
- Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Université, Medical School Saint Antoine, Paris, France
| | | | - Xavier Basagana
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Eric Bateman
- Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Anna Bedbrook
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU, 34295 Montpellier Cedex 5, France
| | - K. S. Bennoor
- Dept of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
| | - Samuel Benveniste
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France
| | - Karl C. Bergmann
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy Member of GA2LEN, Comprehensive Allergy-Centre, Berlin Institute of Health, Berlin, Germany
| | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with the Division of Laboratory Medicine, Warsaw Medical University, Warsaw, Poland
| | - Nils Billo
- Global Alliance against Chronic Respiratory Diseases (WHO GARD), Joensuu, Finland
| | - Carsten Bindslev-Jensen
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
- Termofischer Scientific, Uppsala, Sweden
| | - Leif Bjermer
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
| | - Hubert Blain
- Department of Geriatrics, Montpellier University hospital, Montpellier, France
- EA 2991 Euromov, University Montpellier, Montpellier, France
| | - Mateo Bonini
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- National Heart and Lung Institute, Royal Brompton Hospital & Imperial College, London, UK
| | | | - Jacques Bouchard
- Clinical Medicine, Laval’s University, Quebec City, Canada
- Medicine Department, Hôpital de la Malbaie, Quebec city, QC Canada
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian, University of Health, Kaunas, Lithuania
| | - Christofer E. Brightling
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
| | - Jan Brozek
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
| | - Roland Buhl
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
| | | | - Giorgo W. Canonica
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Victoria Cardona
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron & ARADyAL Research Network, Barcelona, Spain
| | | | - Warner Carr
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA USA
| | | | - Thomas Casale
- Division of Allergy/Immunology, University of South Florida, Tampa, FL USA
| | - Lorenzo Cecchi
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
| | - Alfonso M. Cepeda Sarabia
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia
- SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Colombia
| | - Eka Chkhartishvili
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
| | - Derek K. Chu
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Cemal Cingi
- Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey
| | - Elaine Colgan
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland UK
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal
| | | | - Adnan Custovic
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
| | - Biljana Cvetkosvki
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Woolcock Emphysema Centre, Sydney, Australia
- Sydney Local Health District, Glebe, NSW Australia
| | - Gennaro D’Amato
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Specialty Hospital A.Cardarelli, Naples, Italy
| | - Jane da Silva
- Allergy Service, University Hospital of Federal University of Santa Catarina (HU-UFSC), Florianópolis, Brazil
| | - Carina Dantas
- Cáritas Diocesana de Coimbra, Coimbra, Portugal
- Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
| | - Dejand Dokic
- Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, Republic of Macedonia
| | - Yves Dauvilliers
- Sleep Unit, Department of Neurology, Hôpital Gui-de-Chauliac Montpellier, Inserm U1061, Montpellier, France
| | - Antoni Dedeu
- AQuAS, Barcelna, Spain
- EUREGHA, European Regional and Local Health Association, Brussels, Belgium
| | - Giulia De Feo
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Philippe Devillier
- UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
| | | | - Marc Dykewickz
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
| | - Ruta Dubakiene
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
| | - Motohiro Ebisawa
- Clinical Reserch Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
| | - Yaya El-Gamal
- Pediatric Allergy and Immunology Unit, Children’s hospital, Ain Shams University, Cairo, Egypt
| | - Esben Eller
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
- Termofischer Scientific, Uppsala, Sweden
| | - Regina Emuzyte
- Clinic of Children’s Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
| | - John Farrell
- PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal
| | | | - Alessandro Fiocchi
- Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children’s Research Hospital Holy See, Rome, Italy
| | | | - Bilun Gemicioğlu
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istambul, Turkey
| | | | - Amiran Gamkrelidze
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
| | | | - Maximiliano Gomez
- Allergy & Asthma Unit, Hospital San Bernardo Salta, Salta, Argentina
| | | | - Maia Gotua
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
| | - Nick A. Guldemond
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
| | - Maria-Antonieta Guzmán
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
| | - Jawad Hajjam
- Centich: Centre d’Expertise National des Technologies de l’Information et de la Communication pour l’Autonomie, Gérontopôle Autonomie Longévité des Pays de la Loire, Conseil Régional des Pays de la Loire, Centre d’Expertise Partenariat Européen d’Innovation pour un Vieillissement Actif et en Bonne Santé, Nantes, France
| | - John O’B Hourihane
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
| | - Marc Humbert
- Université Paris-Sud; Service de Pneumologie, Hôpital Bicêtre, Inserm UMR_S999, Le Kremlin Bicêtre, France
| | - Guido Iaccarino
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
| | - Despo Ierodiakonou
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
| | | | - Juan C. Ivancevich
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
| | - Guy Joos
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC Canada
| | - Ki-Suck Jung
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do South Korea
| | - Marek Jutel
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
| | - Omer Kalayci
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
| | - Przemyslaw Kardas
- First Department of Family Medicine, Medical University of Lodz, Łódź, Poland
| | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
| | - Mussa Khaitov
- National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular Immunology, Moscow, Russian Federation
| | | | | | - Marek L. Kowalski
- Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Łódź, Poland
| | - Vicky Kritikos
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Woolcock Emphysema Centre, Sydney, Australia
- Sydney Local Health District, Glebe, NSW Australia
| | - Inger Kull
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sach’s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
| | | | - Philip Lieberman
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, TN USA
| | - Brian Lipworth
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
| | - Karin C. Lodrup Carlsen
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Claudia C. Loureiro
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Renaud Louis
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
| | - Alpana Mair
- DG for Health and Social Care, Scottish Government, Edinburgh, UK
| | - Gert Marien
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Bassam Mahboub
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
| | - Joao Malva
- Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Patrick Manning
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
| | - Esteban De Manuel Keenoy
- Kronikgune, International Centre of Excellence in Chronicity Research Barakaldo, Barakaldo, Bizkaia Spain
| | - Gailen D. Marshall
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS USA
| | - Mohamed R. Masjedi
- Tobacco Control Research Centre, Iranian Anti Tobacco Association, Tehran, Iran
| | - Jorge F. Maspero
- Argentine Association of Allergy and Clinical Immunology, Buenos Aires, Argentina
| | | | - Poalo M. Matricardi
- Department of Pediatric Pneumology and Immunology, AG Molecular Allergology and Immunomodulation, Charité Medical University, Berlin, Germany
| | - Eric Melén
- Sach’s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Elisabete Melo-Gomes
- PNDR, Portuguese National Programme for Respiratory Diseases, Faculdade de Medicina de Lisboa, Lisbon, Portugal
| | - Eli O. Meltzer
- Allergy and Asthma Medical Group and Research Center, San Diego, CA USA
| | | | - Jacques Mercier
- Department of Physiology, CHRU, University Montpellier, Vice President for Research, PhyMedExp, INSERM U1046, CNRS, UMR 9214, Montpellier, France
| | | | - Florin Mihaltan
- National Institute of Pneumology M Nasta, Bucharest, Romania
| | - Branislava Milenkovic
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbian Association for Asthma and COPD, Belgrade, Serbia
| | | | | | - Yousser Mohammad
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
- Syrian Private University, Damascus, Syria
| | - Steve Montefort
- Faculty of Medicine and Surgery, University of Medicine, La Valette, Malta
| | - Ricardo Monti
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Turin, Italy
| | | | - Ralf Mösges
- Institute of Medical Statistics, and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
- CRI-Clinical Research International-Ltd, Hamburg, Germany
| | - Lars Münter
- Danish Commitee for Health Education, Copenhagen East, Denmark
| | - Antonella Muraro
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
| | - Ruth Murray
- MedScript Ltd, Paraparomu, New Zealand
- OPC, Cambridge, UK
| | | | - Luigi Napoli
- Consortium of Pharmacies and Services COSAFER, Salerno, Italy
| | - Leila Namazova-Baranova
- Scientific Centre of Children’s Health under the Russian Academy of Medical Sciences, Moscow, Russia
| | - Hugo Neffen
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
- Center for Allergy and Immunology, Santa Fe, Argentina
| | - Kristoff Nekam
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
| | - Angelo Neou
- Die Hautambulanz and Rothhaar Study Center, Berlin, Germany
| | - Enrico Novellino
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
| | | | - Robin O’Hehir
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia
| | - Ken Ohta
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
| | - Kimi Okubo
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
| | - Gabrielle Onorato
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU, 34295 Montpellier Cedex 5, France
| | - Solange Ouedraogo
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
| | - Isabella Pali-Schöll
- Dept of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine and Medical University, Vienna, Austria
| | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
| | - Peter Panzner
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
| | - Hae-Sim Park
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
| | - Jean-Louis Pépin
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042 and CHU de Grenoble, Grenoble, France
| | - Ana-Maria Pereira
- Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal
- Center for Research in Health Technologies and Information Systems, CINTESIS, Universidade do Porto, Porto, Portugal
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
| | | | - Jim Phillips
- Centre for Empowering Patients and Communities, Faulkland, Somerset, UK
| | - Robert Picard
- Conseil Général de l’Economie Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
| | - Davor Plavec
- Children’s Hospital Srebrnjak, Zagreb, Croatia
- School of Medicine, University J.J. Strossmayer, Osijek, Croatia
| | - Ted A. Popov
- University Hospital ‘Sv Ivan Rilski’, Sofia, Bulgaria
| | - Fabienne Portejoie
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU, 34295 Montpellier Cedex 5, France
| | - David Price
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, Scotland UK
- Research in Real-Life, Cambridge, UK
| | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
| | - Benoit Pugin
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
| | - Filip Raciborski
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
| | | | - Sietze Reitsma
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
| | - Xavier Rodo
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
| | - Antonino Romano
- Allergy Unit, Presidio Columbus, Catholic University of Sacred Heart, Rome, Italy
- IRCCS Oasi Maria SS, Troina, Italy
| | - Nelson Rosario
- Hospital de Clinicas, University of Parana, Paraná, Brazil
| | - Menahenm Rottem
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
| | - Dermot Ryan
- Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
| | | | - Mario M. Sanchez-Borges
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, Caracas, Venezuela
| | - Juan-Carlos Sisul
- Sociedad Paraguaya de Alergia Asma e Inmunologia, Asunción, Paraguay
| | - Dirceu Solé
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
| | - David Somekh
- European Health Futures Forum (EHFF), Dromahair, UK
| | - Talant Sooronbaev
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
| | - Milan Sova
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Otto Spranger
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
| | - Cristina Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
| | - Rafael Stelmach
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital & University of Copenhagen, Copenhagen, Denmark
| | - Michel Thibaudon
- RNSA (Réseau National de Surveillance Aérobiologique), Brussieu, France
| | - Teresa To
- Sidkkids Hospitala and Institute of Health Policy, Management and Evaluation, Toronto, Canada
| | - Ana Todo-Bom
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | | | - Antonio A. Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Rudolph Valenta
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
| | | | - Rianne van der Kleij
- Department of Public Health & Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Olivier Vandenplas
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
| | - Giorgio Vezzani
- Pulmonary Unit, Department of Medical Specialties, Arcispedale SMaria Nuova/IRCCS, AUSL di Reggio Emilia, Reggio Emilia, Italy
| | | | - Giovanni Viegi
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
- CNR Institute of Biomedicine and Molecular Immunology “A Monroy”, Palermo, Italy
| | - Dana Wallace
- Nova Southeastern University, Fort Lauderdale, FL USA
| | - Martin Wagenmann
- Dept of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
| | - De Y. Wang
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
| | - Dennis M. Williams
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC USA
| | - Gary Wong
- Maladies Infectieuses et immunitaires, CHUL, Quebec City, QC Canada
| | - Piotr Wroczynski
- Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with the Division of Laboratory Medicine, Warsaw Medical University, Warsaw, Poland
| | - Panayiotis K. Yiallouros
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
- Department of Pediatrics, Hospital “Archbishop Makarios III”, Nicosia, Cyprus
| | - Arzu Yorgancioglu
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
| | | | - Heahter J. Zar
- Department of Paediatrics and Child Health, Red Cross Children’s Hospital, Cape Town, South Africa
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
| | | | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
| | - Nan S. Zhong
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
| | - the ARIA Study Group
- MACVIA-France, Fondation Partenariale FMC VIA-LR, CHU, 34295 Montpellier Cedex 5, France
- INSERM U 1168, VIMA: Ageing and Chronic Diseases Epidemiological and Public Health Approaches, Villejuif Université Versailles St-Quentin-en-Yvelines, UMR-S 1168, Montigny Le Bretonneux, France
- European Forum for Research and Education in Allergy and Airway Diseases (EUFOREA), Brussels, Belgium
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin, Berlin, Germany
- Department of Dermatology and Allergy Member of GA2LEN, Comprehensive Allergy-Centre, Berlin Institute of Health, Berlin, Germany
- Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON Canada
- Division of Allergy, Immunology, and Transplantation (DAIT), National Institute of Allergy and Infectious Diseases, NIH, Bethesda, USA
- National Institute for Health and Welfare, Helsinki, Finland
- Dept of Otorhinolaryngology, Univ Hospitals Leuven, Louvain, Belgium
- Academic Medical Center, Univ of Amsterdam, Amsterdam, The Netherlands
- Faculty of Medicine, Transylvania University, Brasov, Romania
- Department of Allergy and Immunology, Hospital Quirónsalud Bizkaia, Erandio, Spain
- ISGlobAL, Centre for Research in Environmental Epidemiology (CREAL), Barcelona, Spain
- IMIM (Hospital del Mar Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Upper Airways Research Laboratory, ENT Dept, Ghent University Hospital, Ghent, Belgium
- Dept of Otolaryngology, Head and Neck Surgery, University of Mainz, Mainz, Germany
- Hospital Civil de Guadalajara Dr Juan I Menchaca, Guadalarara, Mexico
- iQ4U Consultants Ltd, London, UK
- Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia
- Woolcock Emphysema Centre, Sydney, Australia
- Sydney Local Health District, Glebe, NSW Australia
- La Rochelle, France
- Quebec Heart and Lung Institute, Laval University, Quebec City, QC Canada
- EIT Health France, Paris, France
- Dept of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
- UCIBIO, REQUINTE, Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (Porto4Ageing), Porto, Portugal
- ProAR–Nucleo de Excelencia em Asma, Federal University of Bahia, Bahia, Brazil
- WHO GARD Planning Group, Salvador, Brazil
- Medical Consulting Czarlewski, Levallois, France
- Department of Otorhinolaryngology, Amsterdam University Medical Centres, AMC, Amsterdam, The Netherlands
- CINTESIS, Center for Research in Health Technology and Information Systems, Faculdade de Medicina da Universidade do Porto, Porto, Portugal
- Medida, Lda Porto, Portugal
- ERS President 2017-2018, Athens Chest Hospital, 7th Resp Med Dept and Asthma Center, Athens, Greece
- Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland
- Division for Health Innovation, Campania Region and Federico II University Hospital Naples (R &D and DISMET), Naples, Italy
- Center for Rhinology and Allergology, Wiesbaden, Germany
- Division of Internal Medicine, Asthma and Allergy, Barlicki University Hospital, Medical University of Lodz, Łódź, Poland
- Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- University of Medicine and Pharmacy, Hochiminh City, Vietnam
- Center of Excellence in Asthma and Allergy, Médica Sur Clinical Foundation and Hospital, México City, Mexico
- KYomed INNOV, Montpellier, France
- Faculty of Health Sciences and CICS–UBI, Health Sciences Research Centre, University of Beira Interior, Covilhã, Portugal
- CIRFF, Federico II University, Naples, Italy
- Rhinology Unit & Smell Clinic, ENT Department, Hospital Clínic, Barcelona, Spain
- Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, CIBERES, University of Barcelona, Barcelona, Spain
- Dept of Otorhinolaryngology, Chiba University Hospital, Chiba, Japan
- Division of Infection, Immunity & Respiratory Medicine, Royal Manchester Children’s Hospital, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, Athens General Children’s Hospital “P&A Kyriakou”, University of Athens, Athens, Greece
- Allergy Department, Pasteur Institute, Paris, France
- Conseil Général de l’Economie Ministère de l’Economie, de l’Industrie et du Numérique, Paris, France
- The Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
- Pneumologie et Soins Intensifs Respiratoires, Hôpitaux Universitaires Paris, Centre Hôpital Cochin, Paris, France
- Department of Internal Medicine, Medical University of Graz, Graz, Austria
- Association Asthme et Allergie, Paris, France
- Department of Prevention of Environmental Hazards and Allergology, Medical University of Warsaw, Warsaw, Poland
- Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Crete, Greece
- International Primary Care Respiratory Group IPCRG, Aberdeen, Scotland UK
- Institute of Clinical Medicine & Institute of Health Sciences, Vilnius University Faculty of Medicine, Vilnius, Lithuania
- Department of Lung Diseases and Clinical Immunology, University of Turku and Terveystalo Allergy Clinic, Turku, Finland
- FILHA, Finnish Lung Association, Helsinki, Finland
- Unit of Geriatric Immunoallergology, University of Bari Medical School, Bari, Italy
- Asthma UK, Mansell Street, London, UK
- Swiss Institute of Allergy and Asthma Research (SIAF), University of Zurich, Davos, Switzerland
- Epidemiology of Allergic and Respiratory Diseases, Department Institute Pierre Louis of Epidemiology and Public Health, INSERM and Sorbonne Université, Medical School Saint Antoine, Paris, France
- Department of Medicine, University of Cape Town, Cape Town, South Africa
- Dept of Respiratory Medicine, National Institute of Diseases of the Chest and Hospital, Dhaka, Bangladesh
- National Center of Expertise in Cognitive Stimulation (CEN STIMCO), Broca Hospital, Paris, France
- Department of Biochemistry and Clinical Chemistry, Faculty of Pharmacy with the Division of Laboratory Medicine, Warsaw Medical University, Warsaw, Poland
- Global Alliance against Chronic Respiratory Diseases (WHO GARD), Joensuu, Finland
- Department of Dermatology and Allergy Centre, Odense University Hospital, Odense Research Center for Anaphylaxis (ORCA), Odense, Denmark
- Termofischer Scientific, Uppsala, Sweden
- Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden
- Department of Geriatrics, Montpellier University hospital, Montpellier, France
- EA 2991 Euromov, University Montpellier, Montpellier, France
- UOC Pneumologia, Istituto di Medicina Interna, F Policlinico Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
- National Heart and Lung Institute, Royal Brompton Hospital & Imperial College, London, UK
- CHU, Dijon, France
- Clinical Medicine, Laval’s University, Quebec City, Canada
- Medicine Department, Hôpital de la Malbaie, Quebec city, QC Canada
- Department of Clinical Pharmacy of Lithuanian, University of Health, Kaunas, Lithuania
- Institute of Lung Health, Respiratory Biomedical Unit, University Hospitals of Leicester NHS Trust, Leicestershire, UK
- Department of Infection, Immunity and Inflammation, University of Leicester, Leicester, UK
- Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Germany
- Municipality Pharmacy, Sarno, Italy
- Personalized Medicine Clinic Asthma & Allergy, Humanitas University, Humanitas Research Hospital, Rozzano, Milan, Italy
- Allergy Section, Department of Internal Medicine, Hospital Vall d’Hebron & ARADyAL Research Network, Barcelona, Spain
- Regional Ministry of Health of Andalusia, Seville, Spain
- Allergy and Asthma Associates of Southern California, Mission Viejo, CA USA
- ASA-Advanced Solutions Accelerator, Clapiers, France
- Division of Allergy/Immunology, University of South Florida, Tampa, FL USA
- SOS Allergology and Clinical Immunology, USL Toscana Centro, Prato, Italy
- Allergy and Immunology Laboratory, Metropolitan University, Simon Bolivar University, Barranquilla, Colombia
- SLaai, Sociedad Latinoamericana de Allergia, Asma e Immunologia, Barranquilla, Colombia
- Chachava Clinic, David Tvildiani Medical University-AIETI Medical School, Grigol Robakidze University, Tbilisi, Georgia
- Medical Faculty, ENT Department, Eskisehir Osmangazi University, Eskisehir, Turkey
- Department of Health, Social Services and Public Safety, Belfast, Northern Ireland UK
- Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal
- PT Government Associate Laboratory, ICVS/3B’s, Braga/Guimarães, Portugal
- Ecole des Mines, Alès, France
- Centre for Respiratory Medicine and Allergy, Institute of Inflammation and Repair, University of Manchester and University Hospital of South Manchester, Manchester, UK
- Division of Respiratory and Allergic Diseases, Department of Respiratory Diseases, High Specialty Hospital A.Cardarelli, Naples, Italy
- Allergy Service, University Hospital of Federal University of Santa Catarina (HU-UFSC), Florianópolis, Brazil
- Cáritas Diocesana de Coimbra, Coimbra, Portugal
- Ageing@Coimbra EIP-AHA Reference Site, Coimbra, Portugal
- Medical Faculty Skopje, University Clinic of Pulmonology and Allergy, Skopje, Republic of Macedonia
- Sleep Unit, Department of Neurology, Hôpital Gui-de-Chauliac Montpellier, Inserm U1061, Montpellier, France
- AQuAS, Barcelna, Spain
- EUREGHA, European Regional and Local Health Association, Brussels, Belgium
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana”, University of Salerno, Salerno, Italy
- UPRES EA220, Pôle des Maladies des Voies Respiratoires, Hôpital Foch, Université Paris-Saclay, Suresnes, France
- Farmacie Dei Golfi Group, Massa Lubrense, Italy
- Section of Allergy and Immunology, Saint Louis University School of Medicine, Saint Louis, MO USA
- Clinic of Infectious, Chest Diseases, Dermatology and Allergology, Vilnius University, Vilnius, Lithuania
- Clinical Reserch Center for Allergy and Rheumatology, Sagamihara National Hospital, Sagamihara, Japan
- Pediatric Allergy and Immunology Unit, Children’s hospital, Ain Shams University, Cairo, Egypt
- Clinic of Children’s Diseases, Faculty of Medicine, Vilnius University, Vilnius, Lithuania
- Global Allergy and Asthma Platform GAAPP, Vienna, Austria
- Division of Allergy, Department of Pediatric Medicine, The Bambino Gesù Children’s Research Hospital Holy See, Rome, Italy
- Reims, France
- Department of Pulmonary Diseases, Istanbul University-Cerrahpasa, Cerrahpasa Faculty of Medicine, Istambul, Turkey
- Allergy Unit, Department of Dermatology, University Hospital of Zurich, Zurich, Switzerland
- National Center for Disease Control and Public Health of Georgia, Tbilisi, Georgia
- Allergy & Asthma Unit, Hospital San Bernardo Salta, Salta, Argentina
- Universidad Autónoma de Nuevo León, San Nicolás de los Garza, Mexico
- Center of Allergy and Immunology, Georgian Association of Allergology and Clinical Immunology, Tbilisi, Georgia
- Institute of Health Policy and Management iBMG, Erasmus University, Rotterdam, The Netherlands
- Immunology and Allergy Division, Clinical Hospital, University of Chile, Santiago, Chile
- Centich: Centre d’Expertise National des Technologies de l’Information et de la Communication pour l’Autonomie, Gérontopôle Autonomie Longévité des Pays de la Loire, Conseil Régional des Pays de la Loire, Centre d’Expertise Partenariat Européen d’Innovation pour un Vieillissement Actif et en Bonne Santé, Nantes, France
- Department of Paediatrics and Child Health, University College Cork, Cork, Ireland
- Université Paris-Sud; Service de Pneumologie, Hôpital Bicêtre, Inserm UMR_S999, Le Kremlin Bicêtre, France
- Department of Medicine and Surgery, University of Salerno, Baronissi, Italy
- Servicio de Alergia e Immunologia, Clinica Santa Isabel, Buenos Aires, Argentina
- Hallym University College of Medicine, Hallym University Sacred Heart Hospital, Anyang, Gyeonggi-do South Korea
- Department of Clinical Immunology, Wrocław Medical University, Wrocław, Poland
- Ukrainian Medical Stomatological Academy, Poltava, Ukraine
- Pediatric Allergy and Asthma Unit, Hacettepe University School of Medicine, Ankara, Turkey
- First Department of Family Medicine, Medical University of Lodz, Łódź, Poland
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, Berlin, Germany
- Institute for Clinical Epidemiology and Biometry, University of Wuerzburg, Würzburg, Germany
- National Research Center, Institute of Immunology, Federal Medicobiological Agency, Laboratory of Molecular Immunology, Moscow, Russian Federation
- GARD Chairman, Geneva, Switzerland
- Allergy & Asthma Center Westend, Berlin, Germany
- Department of Immunology and Allergy, Healthy Ageing Research Center, Medical University of Lodz, Łódź, Poland
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
- Sach’s Children and Youth Hospital, Södersjukhuset, Stockholm, Sweden
- Mattone Internazionale Program, Veneto Region, Italy
- Departments of Internal Medicine and Pediatrics (Divisions of Allergy and Immunology), University of Tennessee College of Medicine, Germantown, TN USA
- Scottish Centre for Respiratory Research, Cardiovascular & Diabetes Medicine, Medical Research Institute, Ninewells Hospital, University of Dundee, Dundee, UK
- Department of Paediatrics, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Imunoalergologia, Centro Hospitalar Universitário de Coimbra and Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Pulmonary Medicine, CHU Sart-Tilman, and GIGA I3 Research Group, Liege, Belgium
- DG for Health and Social Care, Scottish Government, Edinburgh, UK
- Department of Pulmonary Medicine, Rashid Hospital, Dubai, UAE
- Coimbra Institute for Clinical and Biomedical Research (iCBR), Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Medicine (RCSI), Bon Secours Hospital, Glasnevin, Dublin, Ireland
- Kronikgune, International Centre of Excellence in Chronicity Research Barakaldo, Barakaldo, Bizkaia Spain
- Division of Clinical Immunology and Allergy, Laboratory of Behavioral Immunology Research, The University of Mississippi Medical Center, Jackson, MS USA
- Tobacco Control Research Centre, Iranian Anti Tobacco Association, Tehran, Iran
- Argentine Association of Allergy and Clinical Immunology, Buenos Aires, Argentina
- Department of Pediatric Pneumology and Immunology, AG Molecular Allergology and Immunomodulation, Charité Medical University, Berlin, Germany
- Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
- PNDR, Portuguese National Programme for Respiratory Diseases, Faculdade de Medicina de Lisboa, Lisbon, Portugal
- Allergy and Asthma Medical Group and Research Center, San Diego, CA USA
- Department of Physiology, CHRU, University Montpellier, Vice President for Research, PhyMedExp, INSERM U1046, CNRS, UMR 9214, Montpellier, France
- Croatian Pulmonary Society, Zagreb, Croatia
- National Institute of Pneumology M Nasta, Bucharest, Romania
- Clinic for Pulmonary Diseases, Clinical Center of Serbia, Faculty of Medicine, University of Belgrade, Serbian Association for Asthma and COPD, Belgrade, Serbia
- Regione Piemonte, Turin, Italy
- Mexico City, Mexico
- National Center for Research in Chronic Respiratory Diseases, Tishreen University School of Medicine, Latakia, Syria
- Syrian Private University, Damascus, Syria
- Faculty of Medicine and Surgery, University of Medicine, La Valette, Malta
- Department of Medical Sciences, Allergy and Clinical Immunology Unit, University of Torino & Mauriziano Hospital, Turin, Italy
- Allergy Center, CUF Descobertas Hospital, Lisbon, Portugal
- Institute of Medical Statistics, and Computational Biology, Medical Faculty, University of Cologne, Cologne, Germany
- CRI-Clinical Research International-Ltd, Hamburg, Germany
- Danish Commitee for Health Education, Copenhagen East, Denmark
- Food Allergy Referral Centre Veneto Region, Department of Women and Child Health, Padua General University Hospital, Padua, Italy
- MedScript Ltd, Paraparomu, New Zealand
- OPC, Cambridge, UK
- Johns Hopkins School of Medicine, Baltimore, MD USA
- Consortium of Pharmacies and Services COSAFER, Salerno, Italy
- Scientific Centre of Children’s Health under the Russian Academy of Medical Sciences, Moscow, Russia
- Center of Allergy, Immunology and Respiratory Diseases, Santa Fe, Argentina
- Center for Allergy and Immunology, Santa Fe, Argentina
- Hospital of the Hospitaller Brothers in Buda, Budapest, Hungary
- Die Hautambulanz and Rothhaar Study Center, Berlin, Germany
- Department of Pharmacy, University of Naples Federico II, Naples, Italy
- ENT Department, University Hospital of Kinshasa, Kinshasa, Congo
- Department of Allergy, Immunology and Respiratory Medicine, Alfred Hospital and Central Clinical School, Monash University, Melbourne, VIC Australia
- Dept of Otolaryngology, Nippon Medical School, Tokyo, Japan
- Centre Hospitalier Universitaire Pédiatrique Charles de Gaulle, Ouagadougou, Burkina Faso
- Dept of Comparative Medicine, Messerli Research Institute of the University of Veterinary Medicine and Medical University, Vienna, Austria
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations, Brussels, Belgium
- Department of Immunology and Allergology, Faculty of Medicine and Faculty Hospital in Pilsen, Charles University in Prague, Pilsen, Czech Republic
- Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, South Korea
- Laboratoire HP2, Université Grenoble Alpes, Grenoble, France
- INSERM, U1042 and CHU de Grenoble, Grenoble, France
- Allergy Unit, CUF-Porto Hospital and Institute, Porto, Portugal
- Center for Research in Health Technologies and Information Systems, CINTESIS, Universidade do Porto, Porto, Portugal
- Maladies Infectieuses et immunitaires, CHUL, Quebec City, QC Canada
- Department of Otorhinolaryngology, Head and Neck Surgery, Section of Rhinology and Allergy, University Hospital Marburg, Philipps-Universität Marburg, Marburg, Germany
- Farmacias Holon, Lisbon, Portugal
- Centre for Empowering Patients and Communities, Faulkland, Somerset, UK
- Children’s Hospital Srebrnjak, Zagreb, Croatia
- School of Medicine, University J.J. Strossmayer, Osijek, Croatia
- University Hospital ‘Sv Ivan Rilski’, Sofia, Bulgaria
- Academic Centre of Primary Care, University of Aberdeen, Aberdeen, Scotland UK
- Research in Real-Life, Cambridge, UK
- Department of Otorhinolaryngology, University of Crete School of Medicine, Heraklion, Greece
- Department of Nephrology and Endocrinology, Karolinska University Hospital, Stockholm, Sweden
- Allergy Unit, Presidio Columbus, Catholic University of Sacred Heart, Rome, Italy
- IRCCS Oasi Maria SS, Troina, Italy
- Hospital de Clinicas, University of Parana, Paraná, Brazil
- Division of Allergy Asthma and Clinical Immunology, Emek Medical Center, Afula, Israel
- Allergy and Respiratory Research Group, The University of Edinburgh, Edinburgh, UK
- Association of Finnish Pharmacists, Helsinki, Finland
- Allergy and Clinical Immunology Department, Centro Médico-Docente la, Trinidad and Clínica El Avila, Caracas, Venezuela
- Sociedad Paraguaya de Alergia Asma e Inmunologia, Asunción, Paraguay
- Division of Allergy, Clinical Immunology and Rheumatology, Department of Pediatrics, Federal University of São Paulo, São Paulo, Brazil
- European Health Futures Forum (EHFF), Dromahair, UK
- Kyrgyzstan National Centre of Cardiology and Internal Medicine, Euro-Asian Respiratory Society, Bishkek, Kyrgyzstan
- Department of Respiratory Medicine, University Hospital Olomouc, Olomouc, Czech Republic
- Pulmonary Division, Heart Institute (InCor), Hospital da Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
- Department of Respiratory Medicine, Hvidovre Hospital & University of Copenhagen, Copenhagen, Denmark
- RNSA (Réseau National de Surveillance Aérobiologique), Brussieu, France
- Sidkkids Hospitala and Institute of Health Policy, Management and Evaluation, Toronto, Canada
- Department of ENT, Medical University of Graz, Graz, Austria
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy, IDIBAPS, University of Barcelona, Barcelona, Spain
- Division of Immunopathology, Department of Pathophysiology and Allergy Research, Center for Pathophysiology, Infectiology and Immunology, Medical University of Vienna, Vienna, Austria
- NRC Institute of Immunology FMBA of Russia, Moscow, Russia
- Laboratory of Immunopathology, Department of Clinical Immunology and Allergy, Sechenov First Moscow State Medical University, Moscow, Russia
- Montevideo, Uruguay
- Department of Public Health & Primary Care, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Obstetrics and Gynaecology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
- Department of Chest Medicine, Centre Hospitalier Universitaire UCL Namur, Université Catholique de Louvain, Yvoir, Belgium
- Pulmonary Unit, Department of Medical Specialties, Arcispedale SMaria Nuova/IRCCS, AUSL di Reggio Emilia, Reggio Emilia, Italy
- Pulmonary Environmental Epidemiology Unit, CNR Institute of Clinical Physiology, Pisa, Italy
- CNR Institute of Biomedicine and Molecular Immunology “A Monroy”, Palermo, Italy
- Nova Southeastern University, Fort Lauderdale, FL USA
- Dept of Otorhinolaryngology, HNO-Klinik, Universitätsklinikum Düsseldorf, Düsseldorf, Germany
- Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Department of Medicine, Clinical Immunology and Allergy, McMaster University, Hamilton, ON Canada
- Centre for Clinical Research Sörmland, Uppsala University, Eskilstuna, Sweden
- Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC USA
- Cyprus International Institute for Environmental & Public Health in Association with Harvard School of Public Health, Cyprus University of Technology, Limassol, Cyprus
- Department of Pediatrics, Hospital “Archbishop Makarios III”, Nicosia, Cyprus
- Department of Pulmonary Diseases, Celal Bayar University, Faculty of Medicine, Manisa, Turkey
- The Allergy and Asthma Institute, Islamabad, Pakistan
- Department of Paediatrics and Child Health, Red Cross Children’s Hospital, Cape Town, South Africa
- MRC Unit on Child & Adolescent Health, University of Cape Town, Cape Town, South Africa
- Bull DSAS, Echirolles, France
- Universidad Católica de Córdoba, Córdoba, Argentina
- Department of Otolaryngology Head and Neck Surgery, Beijing TongRen Hospital and Beijing Institute of Otolaryngology, Beijing, China
- State Key Laboratory of Respiratory Diseases, Guangzhou Institute of Respiratory Disease, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China
- University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia
- National Hospital Organization, Tokyo National Hospital, Tokyo, Japan
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Kuipers E, Wensing M, Wong-Go E, Daemen BJG, De Smet PAGM, Teichert M. Adherence to guideline recommendations for asthma care in community pharmacies: actual and needed performance. NPJ Prim Care Respir Med 2019; 29:26. [PMID: 31296863 PMCID: PMC6624277 DOI: 10.1038/s41533-019-0139-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Accepted: 06/17/2019] [Indexed: 12/03/2022] Open
Abstract
Pharmaceutical care guidelines aim to provide recommendations for pharmaceutical care, reduce unwanted pharmacy practice variation and ultimately improve the quality of healthcare. This study evaluated community pharmacists’ adherence to recommendations for the provision of care to asthma patients with first dispensing and follow-up refill encounters in The Netherlands. Data were pharmacists’ self-assessment of adherence to guideline recommendations, independent observations of dispensing encounters and a nationwide questionnaire on pharmacists’ views on the desirable (clinical) necessity of applying guideline recommendations to their patient population. The 21 pharmacists who performed self-assessment judged their adherence concerning inhalation instructions as high. The lowest scores were reported for recommendations to collect additional information on the type of lung disease and for asking patients’ expectations, wishes and concerns. Sixty-eight dispensing encounters were observed. In 83% of the 35 first dispensing observations, inhalation instruction was provided. This percentage was lower (62%) at refill dispensings. During all encounters, pharmacy staff seldom explored patients’ perceptions or responded to patients’ expectations, wishes and concerns. One hundred and four pharmacists completed the feasibility questionnaire. Pharmacists judged that all patients should receive inhalation instruction at first dispensing. They regarded it necessary to check on patients’ expectations, wishes and concerns regarding the treatment for only up to 70% of the patients. More efforts on guideline implementation are needed, especially on follow-up dispensings and on gaining relevant information from patients and other healthcare professionals. Pharmacists still have opportunities to grow in applying a patient-tailored approach and exploring patients’ individual needs, rather than providing practical information.
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Affiliation(s)
- Esther Kuipers
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands. .,BENU Apotheek Zeist West, Zeist, The Netherlands.
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Elaine Wong-Go
- Royal Dutch Association for the Advancement of Pharmacy (KNMP), Guideline Development, The Hague, The Netherlands
| | - Bernard J G Daemen
- Royal Dutch Association for the Advancement of Pharmacy (KNMP), Guideline Development, The Hague, The Netherlands
| | - Peter A G M De Smet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, PO Box 9101, 6500 HB, Nijmegen, The Netherlands.,Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, The Netherlands
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13
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Bosnic‐Anticevich S, Costa E, Menditto E, Lourenço O, Novellino E, Bialek S, Briedis V, Buonaiuto R, Chrystyn H, Cvetkovski B, Di Capua S, Kritikos V, Mair A, Orlando V, Paulino E, Salimäki J, Söderlund R, Tan R, Williams DM, Wroczynski P, Agache I, Ansotegui IJ, Anto JM, Bedbrook A, Bachert C, Bewick M, Bindslev‐Jensen C, Brozek JL, Canonica GW, Cardona V, Carr W, Casale TB, Chavannes NH, Correia de Sousa J, Cruz AA, Czarlewski W, De Carlo G, Demoly P, Devillier P, Dykewicz MS, Gaga M, El‐Gamal Y, Fonseca J, Fokkens WJ, Guzmán MA, Haahtela T, Hellings PW, Illario M, Ivancevich JC, Just J, Kaidashev I, Khaitov M, Khaltaev N, Keil T, Klimek L, Kowalski ML, Kuna P, Kvedariene V, Larenas‐Linnemann DE, Laune D, Le LTT, Lodrup Carlsen KC, Mahboub B, Maier D, Malva J, Manning PJ, Morais‐Almeida M, Mösges R, Mullol J, Münter L, Murray R, Naclerio R, Namazova‐Baranova L, Nekam K, Nyembue TD, Okubo K, O'Hehir RE, Ohta K, Okamoto Y, Onorato GL, Palkonen S, Panzner P, Papadopoulos NG, Park H, Pawankar R, Pfaar O, Phillips J, Plavec D, Popov TA, Potter PC, Prokopakis EP, Roller‐Wirnsberger RE, Rottem M, Ryan D, Samolinski B, Sanchez‐Borges M, Schunemann HJ, Sheikh A, Sisul JC, Somekh D, Stellato C, To T, Todo‐Bom AM, Tomazic PV, Toppila‐Salmi S, Valero A, Valiulis A, Valovirta E, Ventura MT, Wagenmann M, Wallace D, Waserman S, Wickman M, Yiallouros PK, Yorgancioglu A, Yusuf OM, Zar HJ, Zernotti ME, Zhang L, Zidarn M, Zuberbier T, Bousquet J. ARIA pharmacy 2018 "Allergic rhinitis care pathways for community pharmacy": AIRWAYS ICPs initiative (European Innovation Partnership on Active and Healthy Ageing, DG CONNECT and DG Santé) POLLAR (Impact of Air POLLution on Asthma and Rhinitis) GARD Demonstration project. Allergy 2019; 74:1219-1236. [PMID: 30565275 DOI: 10.1111/all.13701] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Revised: 09/22/2018] [Accepted: 10/11/2018] [Indexed: 12/16/2022]
Abstract
Pharmacists are trusted health care professionals. Many patients use over-the-counter (OTC) medications and are seen by pharmacists who are the initial point of contact for allergic rhinitis management in most countries. The role of pharmacists in integrated care pathways (ICPs) for allergic diseases is important. This paper builds on existing studies and provides tools intended to help pharmacists provide optimal advice/interventions/strategies to patients with rhinitis. The Allergic Rhinitis and its Impact on Asthma (ARIA)-pharmacy ICP includes a diagnostic questionnaire specifically focusing attention on key symptoms and markers of the disease, a systematic Diagnosis Guide (including differential diagnoses), and a simple flowchart with proposed treatment for rhinitis and asthma multimorbidity. Key prompts for referral within the ICP are included. The use of technology is critical to enhance the management of allergic rhinitis. However, the ARIA-pharmacy ICP should be adapted to local healthcare environments/situations as regional (national) differences exist in pharmacy care.
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Affiliation(s)
- Sinthia Bosnic‐Anticevich
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Elisio Costa
- UCIBIO REQUIMTE Faculty of Pharmacy and Competence Center on Active and Healthy Ageing of University of Porto (AgeUPNetWork) University of Porto Porto Portugal
| | | | - Olga Lourenço
- Faculty of Health Sciences and CICS – UBI Health Sciences Research Centre University of Beira Interior Covilhã Portugal
| | - Ettore Novellino
- Department of Pharmacy of University of Naples Federico II Naples Italy
| | - Slawomir Bialek
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | - Vitalis Briedis
- Department of Clinical Pharmacy of Lithuanian University of Health Sciences Kaunas Lithuania
| | | | | | - Biljana Cvetkovski
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | | | - Vicky Kritikos
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Alpana Mair
- DG for Health and Social Care Scottish Government Edinburgh UK
| | | | | | | | - Rojin Söderlund
- Department of Nephrology and Endocrinology Karolinska University Hospital Stockholm Sweden
| | - Rachel Tan
- Woolcock Institute of Medical Research University of Sydney and Sydney Local Health District Glebe New South Wales Australia
| | - Dennis M. Williams
- Eshelman School of Pharmacy University of North Carolina Chapel Hill North Carolina
| | - Piotr Wroczynski
- Department of Biochemistry and Clinical Chemistry Faculty of Pharmacy with the Division of Laboratory Medicine Warsaw Medical University Warsaw Poland
| | | | | | - Josep M. Anto
- ISGlobAL Centre for Research in Environmental Epidemiology (CREAL) Barcelona Spain
- IMIM (Hospital del Mar Research Institute) Barcelona Spain
- CIBER Epidemiología y Salud Pública (CIBERESP) Barcelona Spain
- Universitat Pompeu Fabra (UPF) Barcelona Spain
| | - Anna Bedbrook
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
| | - Claus Bachert
- Upper Airways Research Laboratory ENT Department Ghent University Hospital Ghent Belgium
| | | | - Carsten Bindslev‐Jensen
- Department of Dermatology and Allergy Centre Odense University Hospital Odense Research Center for Anaphylaxis (ORCA) Odense Denmark
| | - Jan L. Brozek
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Giorgio Walter Canonica
- Personalized Medicine Clinic Asthma & Allergy Humanitas Research Hospital Humanitas University Rozzano, Milan Italy
| | - Victoria Cardona
- Allergy Section Department of Internal Medicine Hospital Vall ‘dHebron & ARADyAL Research Network Barcelona Spain
| | - Warner Carr
- Allergy and Asthma Associates of Southern California Mission Viejo California
| | - Thomas B. Casale
- Division of Allergy/Immunology University of South Florida Tampa Florida
| | - Niels H. Chavannes
- Department of Public Health and Primary Care Leiden University Medical Center Leiden The Netherlands
| | - Jaime Correia de Sousa
- Life and Health Sciences Research Institute (ICVS) School of Medicine University of Minho Braga Portugal
- ICVS/3B's PT Government Associate Laboratory Braga/Guimarães Portugal
| | - Alvaro A. Cruz
- ProAR – Nucleo de Excelencia em Asma Federal University of Bahia Bahia Brazil
- WHO GARD Planning Group Brasilia Brazil
| | | | - Giuseppe De Carlo
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Pascal Demoly
- Department of Respiratory Diseases Montpellier University Hospital Montpellier France
- Epidemiology of Allergic and Respiratory Diseases Department Institute Pierre Louis of Epidemiology and Public Health Medical School Saint Antoine INSERM and UPMC Sorbonne Université Paris France
| | - Philippe Devillier
- Laboratoire de Pharmacologie Respiratoire UPRES EA220 Hôpital Foch Suresnes Université Versailles Saint‐Quentin Université Paris Saclay Saclay France
| | - Mark S. Dykewicz
- Section of Allergy and Immunology Saint Louis University School of Medicine Saint Louis Missouri
| | - Mina Gaga
- ERS President 2017‐2018 Athens Chest Hospital 7th Resp Med Department and Asthma Center Athens Greece
| | - Yehia El‐Gamal
- Pediatric Allergy and Immunology Unit Children's Hospital Ain Shams University Cairo Egypt
| | - João Fonseca
- CINTESIS Center for Research in Health Technologies and Information Systems Faculdade de Medicina da Universidade do Porto Porto Portugal
- MEDIDA, Lda Porto Portugal
| | - Wytske J. Fokkens
- Department of Otorhinolaryngology Academic Medical Centre Amsterdam The Netherlands
| | | | - Tari Haahtela
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Peter W. Hellings
- Laboratory of Clinical Immunology Department of Microbiology and Immunology KU Leuven Leuven Belgium
| | - Maddalena Illario
- Division for Health Innovation Campania Region and Federico II University Hospital Naples (R&D and DISMET) Naples Italy
| | | | - Jocelyne Just
- Allergology Department Centre de l'Asthme et des Allergies Hôpital d'Enfants Armand‐Trousseau (APHP) Sorbonne Universités UPMC Univ Paris 06 UMR_S 1136 Institut Pierre Louis d'Epidémiologie et de Santé Publique Equipe EPAR Paris France
| | - Igor Kaidashev
- Ukrainian Medical Stomatological Academy Poltava Ukraine
| | - Musa Khaitov
- National Research Center Institute of Immunology Federal Medicobiological Agency Laboratory of Molecular immunology Moscow Russian Federation
| | | | - Thomas Keil
- Institute of Social Medicine, Epidemiology and Health Economics Charité ‐ Universitätsmedizin Berlin Berlin Germany
- Institute for Clinical Epidemiology and Biometry University of Wuerzburg Wuerzburg Germany
| | - Ludger Klimek
- Center for Rhinology and Allergology Wiesbaden Germany
| | - Marek L. Kowalski
- Department of Immunology and Allergy Healthy Ageing Research Center Medical University of Lodz Lodz Poland
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Barlicki University Hospital Medical University of Lodz Lodz Poland
| | | | | | | | - Lan T. T. Le
- University of Medicine and Pharmacy Hochiminh City Vietnam
| | - Karin C. Lodrup Carlsen
- Department of Paediatrics Oslo University Hospital Oslo Norway
- Faculty of Medicine Institute of Clinical MedicineUniversity of Oslo Oslo Norway
| | - Bassam Mahboub
- Department of Pulmonary Medicine Rashid Hospital Dubai UAE
| | | | - Joao Malva
- Faculty of Medicine Coimbra Institute for Clinical and Biomedical Research (iCBR) University of Coimbra Coimbra Portugal
- Ageing@Coimbra EIP‐AHA Reference Site Coimbra Portugal
| | - Patrick J. Manning
- Department of Medicine (RCSI) Bon Secours Hospital Glasnevin, Dublin Ireland
| | | | - Ralph Mösges
- Institute of Medical Statistics, and Computational Biology Medical Faculty University of Cologne Cologne Germany
- CRI‐Clinical Research International‐Ltd Hamburg Germany
| | - Joaquim Mullol
- Rhinology Unit & Smell Clinic ENT Department Hospital Clínic, Clinical & Experimental Respiratory Immunoallergy IDIBAPS CIBERES University of Barcelona Barcelona Spain
| | - Lars Münter
- Danish Committee for Health Education Copenhagen East Denmark
| | | | | | - Leyla Namazova‐Baranova
- Scientific Centre of Children's Health under the MoH, Russia, Russian National Research Medical University named Pirogov Moscow Russia
| | - Kristof Nekam
- Hospital of the Hospitaller Brothers in Buda Budapest Hungary
| | | | - Kimi Okubo
- Department of Otolaryngology Nippon Medical School Tokyo Japan
| | - Robyn E. O'Hehir
- Department of Allergy, Immunology and Respiratory Medicine Alfred Hospital and Central Clinical School Monash University Melbourne Victoria Australia
- Department of Immunology Monash University Melbourne Victoria Australia
| | - Ken Ohta
- National Hospital Organization Tokyo National Hospital Tokyo Japan
| | - Yoshitaka Okamoto
- Department of Otorhinolaryngology Chiba University Hospital Chiba Japan
| | | | - Susanna Palkonen
- EFA European Federation of Allergy and Airways Diseases Patients’ Associations Brussels Belgium
| | - Petr Panzner
- Department of Immunology and Allergology Faculty of Medicine and Faculty Hospital in Pilsen Charles University in Prague Pilsen Czech Republic
| | - Nikolaos G. Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine Royal Manchester Children's Hospital University of Manchester Manchester UK
- Allergy Department 2nd Pediatric Clinic Athens General Children's Hospital “P&A Kyriakou” University of Athens Athens Greece
| | - Hae‐Sim Park
- Department of Allergy and Clinical Immunology Ajou University School of Medicine Suwon South Korea
| | - Ruby Pawankar
- Department of Pediatrics Nippon Medical School Tokyo Japan
| | - Oliver Pfaar
- Department of Otorhinolaryngology, Head and Neck Surgery Section for Rhinology and Allergy University Hospital Marburg Philipps‐Universität Marburg Marburg Germany
| | - Jim Phillips
- Centre for Empowering Patients and Communities Faulkland, Somerset UK
| | - Davor Plavec
- Children's Hospital Srebrnjak Zagreb, School of Medicine University J.J. Strossmayer Osijek Croatia
| | | | - Paul C. Potter
- Allergy Diagnostic and Clinical Research Unit University of Cape Town Lung Institute Cape Town South Africa
| | - Emmanuel P. Prokopakis
- Department of Otorhinolaryngology University of Crete School of Medicine Heraklion Greece
| | | | - Menachem Rottem
- Division of Allergy Asthma and Clinical Immunology Emek Medical Center Afula Israel
| | - Dermot Ryan
- Honorary Clinical Research Fellow Allergy and Respiratory Research Group The University of Edinburgh Past President SLAAI FACAAI Edinburgh UK
| | - Bolesław Samolinski
- Department of Prevention of Environmental Hazards and Allergology Medical University of Warsaw Warsaw Poland
| | - Mario Sanchez‐Borges
- Allergy and Clinical Immunology Department Centro Médico‐Docente la Trinidad Caracas Trinidad
- Clínica El Avila Altamira, Caracas Venezuela
| | - Holger J. Schunemann
- Department of Health Research Methods, Evidence, and Impact Division of Immunology and Allergy Department of Medicine McMaster University Hamilton Ontario Canada
| | - Aziz Sheikh
- The Usher Institute of Population Health Sciences and Informatics The University of Edinburgh Edinburgh UK
| | | | - David Somekh
- European Health Futures Forum (EHFF) Isle of Wright UK
| | - Cristiana Stellato
- Department of Medicine, Surgery and Dentistry “Scuola Medica Salernitana” University of Salerno Salerno Italy
| | - Teresa To
- The Hospital for Sick Children Dalla Lana School of Public Health University of Toronto Toronto Ontario Canada
| | - Ana Maria Todo‐Bom
- Imunoalergologia Centro Hospitalar Universitário de Coimbra Coimbra Portugal
- Faculty of Medicine University of Coimbra Coimbra Portugal
| | | | - Sanna Toppila‐Salmi
- Skin and Allergy Hospital Helsinki University Hospital Helsinki Finland
- University of Helsinki Helsinki Finland
| | - Antonio Valero
- Pneumology and Allergy Department CIBERES and Clinical & Experimental Respiratory Immunoallergy IDIBAPS University of Barcelona Barcelona Spain
| | - Arunas Valiulis
- Clinic of Children's Diseases and Institute of Health Sciences Department of Public Health Vilnius University Institute of Clinical Medicine Vilnius Lithuania
- European Academy of Paediatrics (EAP/UEMS‐SP) Brussels Belgium
| | - Errka Valovirta
- Department of Lung Diseases and Clinical Immunology University of Turku and Terveystalo allergy clinic Turku Finland
| | - Maria Teresa Ventura
- Unit of Geriatric Immunoallergology University of Bari Medical School Bari Italy
| | - Martin Wagenmann
- Department of Otorhinolaryngology Universitätsklinikum Düsseldorf Dusseldorf Germany
| | - Dana Wallace
- Nova Southeastern University Fort Lauderdale Florida
| | - Susan Waserman
- Department of Medicine, Clinical Immunology and Allergy McMaster University Hamilton Ontario Canada
| | - Magnus Wickman
- Centre for Clinical Research Sörmland Uppsala University Eskilstuna Sweden
| | - Panayiotis K. Yiallouros
- Cyprus International Institute for Environmenta & Public Health in Association with Harvard School of Public Health Cyprus University of Technology Limassol Cyprus
- Department of Pediatrics Hospital “Archbishop Makarios III” Nicosia Cyprus
| | | | | | - Heather J. Zar
- Department of Paediatrics and Child Health Red Cross Children's, Hospital, and MRC Unit on Child & Adolescent Health University of Cape Town Cape Town South Africa
| | | | - Luo Zhang
- Department of Otolaryngology Head and Neck Surgery Beijing TongRen Hospital Beijing Institute of Otolaryngology Beijing China
| | - Mihaela Zidarn
- University Clinic of Respiratory and Allergic Diseases Golnik Slovenia
| | - Torsten Zuberbier
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
| | - Jean Bousquet
- MACVIA‐France Fondation Partenariale FMC VIA‐LR Montpellier France
- Department of Dermatology and AllergyCharité – Universitätsmedizin Berlin Corporate Member of Freie Universität Berlin Humboldt‐Universität zu Berlin Berlin Institute of Health Comprehensive Allergy Center A member of GALEN Berlin Germany
- University Hospital Montpellier France
- INSERM U 1168 VIMA: Ageing and chronic diseases Epidemiological and public health approaches Villejuif France
- Université Versailles St‐Quentin‐en‐Yvelines UMR‐S 1168 Montigny le Bretonneux France
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14
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Kuipers E, Poot CC, Wensing M, Chavannes NH, de Smet PA, Teichert M. Self-Management Maintenance Inhalation Therapy With eHealth (SELFIE): Observational Study on the Use of an Electronic Monitoring Device in Respiratory Patient Care and Research. J Med Internet Res 2019; 21:e13551. [PMID: 31148542 PMCID: PMC6658221 DOI: 10.2196/13551] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 03/20/2019] [Accepted: 03/23/2019] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Electronic inhalation monitoring devices (EIMDs) are available to remind patients with respiratory diseases to take their medication and register inhalations for feedback to patients and health care providers as well as for data collection in research settings. OBJECTIVE This study aimed to assess the validity as well as the patient-reported usability and acceptability of an EIMD. METHODS This observational study planned to include 21 community pharmacies in the Netherlands. Patient-reported inhalations were collected and compared to EIMD registrations to evaluate the positive predictive value of these registrations as actual patient inhalations. Patients received questionnaires on their experiences and acceptance. RESULTS A convenience sample of 32 patients was included from across 18 pharmacies, and 932 medication doses were validated. Of these, 796 registrations matched with patient-reported use (true-positive, 85.4%), and 33 inhalation registrations did not match with patient-reported use (false-positive, 3.5%). The positive predictive value was 96.0%, and 103 patient-reported inhalations were not recorded in the database (false-negative, 11.1%). Overall, patients considered the EIMD to be acceptable and easy to use, but many hesitated to continue its use. Reminders and motivational messages were not appreciated by all users, and more user-tailored features in the app were desired. CONCLUSIONS Patients' interaction with the device in real-world settings is critical for objective measurement of medication adherence. The positive predictive value of this EIMD was found to be acceptable. However, patients reported false-negative registrations and a desire to include more user-tailored features to increase the usability and acceptability of the EIMD.
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Affiliation(s)
- Esther Kuipers
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,BENU Apotheek Zeist West, Zeist, Netherlands
| | - Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Michel Wensing
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of General Practice and Health Services Research, University Hospital Heidelberg, Heidelberg, Germany
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands
| | - Peter Agm de Smet
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands.,Department of Clinical Pharmacy, Radboud Institute for Health Sciences, Radboud University Medical Centre, Nijmegen, Netherlands
| | - Martina Teichert
- Department of Clinical Pharmacy & Toxicology, Leiden University Medical Centre, Leiden, Netherlands
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