1
|
The Role of Access and Cost-Effectiveness in Managing Asthma: A Systematic Review. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY: IN PRACTICE 2022; 10:2109-2116. [PMID: 35525532 PMCID: PMC9353043 DOI: 10.1016/j.jaip.2022.04.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2021] [Revised: 03/25/2022] [Accepted: 04/12/2022] [Indexed: 12/21/2022]
Abstract
Background Inconsistent and unequal access to medical care is an issue that predates the COVID19 pandemic, which only worsened the problem. Limited access to care from asthma specialists and other specialists treating comorbid diseases may adversely affect asthma. Objective The purpose of this review is to identify health disparities associated with access to care for asthma, and cost-effectiveness of therapies and interventions addressing this health disparity. Methods A narrative systematic review was undertaken using MeSH searches of English language articles published in CINAHL, Scopus, or PubMed. Results A total of 725 articles were identified. Barriers recognized from the literature included access to diagnostic spirometry, access to specialists, medication formulary restrictions, and issues leading to medical nonadherence. Telemedicine, school-based health care interventions, digital applications, and non–office-based digital spirometry could be used to address these gaps in access to asthma care while potentially being cost-effective. Conclusion With the widespread adoption of telemedicine because of the pandemic, and adoption of other mobile services, we now have potential tools that can increase access to asthma care, which can help address this health care inequity. Evidence is limited, but favorable, that some of these tools may be cost-effective.
Collapse
|
2
|
Generoso A, Muglia-Chopra C, Oppenheimer J. Prospects for Monoclonal Antibody Therapy in Pediatric Asthma. Curr Allergy Asthma Rep 2018; 18:45. [PMID: 29992472 DOI: 10.1007/s11882-018-0799-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
PURPOSE OF REVIEW The profile of biologic therapies for asthma is growing rapidly. We discuss how to match the proper pediatric patient with the most effective therapy. RECENT FINDINGS Currently available biologic therapies are most effective in patients with T2 high asthma. Newer drugs are currently being studied which target TSLP and interleukin 33. These newer drugs may provide options for asthmatics who do not respond to the current anti-IgE, anti-IL5, and anti-IL4/13 therapies. Asthma is a heterogeneous disease which can be driven by different inflammatory mediators in different patients. To select the most effective biologic therapy for a pediatric patient, the asthma phenotype must first be determined. The steep cost of biologics limits their use, which makes proper pairing of patient to therapy even more crucial. Presently, several therapies exist for T2 high asthma, but it is hoped in the future that development of drugs effective for T2 low asthmatics will be available as well.
Collapse
Affiliation(s)
- August Generoso
- Rutgers New Jersey Medical School, The State University of New Jersey, 90 Bergen Street, Newark, NJ, 07103, USA
| | - Christine Muglia-Chopra
- Rutgers New Jersey Medical School, The State University of New Jersey, 90 Bergen Street, Newark, NJ, 07103, USA
| | - John Oppenheimer
- Rutgers New Jersey Medical School, The State University of New Jersey, 90 Bergen Street, Newark, NJ, 07103, USA.
| |
Collapse
|
3
|
Oppenheimer JJ, Greenberger PA. Baseline asthma burden, comorbidities, and biomarkers in omalizumab-treated patients in PROSPERO. Ann Allergy Asthma Immunol 2018; 119:474-475. [PMID: 29223296 DOI: 10.1016/j.anai.2017.10.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2017] [Accepted: 10/15/2017] [Indexed: 02/06/2023]
|
4
|
Lee J, Tay TR, Radhakrishna N, Hore-Lacy F, Mackay A, Hoy R, Dabscheck E, O'Hehir R, Hew M. Nonadherence in the era of severe asthma biologics and thermoplasty. Eur Respir J 2018. [PMID: 29519922 PMCID: PMC5884695 DOI: 10.1183/13993003.01836-2017] [Citation(s) in RCA: 73] [Impact Index Per Article: 12.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Nonadherence to inhaled preventers impairs asthma control. Electronic monitoring devices (EMDs) can objectively measure adherence. Their use has not been reported in difficult asthma patients potentially suitable for novel therapies, i.e. biologics and bronchial thermoplasty.Consecutive patients with difficult asthma were assessed for eligibility for novel therapies. Medication adherence, defined as taking >75% of prescribed doses, was assessed by EMD and compared with standardised clinician assessment over an 8-week period.Among 69 difficult asthma patients, adherence could not be analysed in 13, due to device incompatibility or malfunction. Nonadherence was confirmed in 20 out of 45 (44.4%) patients. Clinical assessment of nonadherence was insensitive (physician 15%, nurse 28%). Serum eosinophils were higher in nonadherent patients. Including 11 patients with possible nonadherence (device refused or not returned) increased the nonadherence rate to 31 out of 56 (55%) patients. Severe asthma criteria were fulfilled by 59 out of 69 patients. 47 were eligible for novel therapies, with confirmed nonadherence in 16 out of 32 (50%) patients with EMD data; including seven patients with possible nonadherence increased the nonadherence rate to 23 out of 39 (59%).At least half the patients eligible for novel therapies were nonadherent to preventers. Nonadherence was often undetectable by clinical assessments. Preventer adherence must be confirmed objectively before employing novel severe asthma therapies.
Collapse
Affiliation(s)
- Joy Lee
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Tunn Ren Tay
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia
| | - Naghmeh Radhakrishna
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia
| | - Fiona Hore-Lacy
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia
| | - Anna Mackay
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia
| | - Ryan Hoy
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Eli Dabscheck
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Robyn O'Hehir
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia.,Allergy, Immunology and Respiratory Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - Mark Hew
- Allergy, Asthma and Clinical Immunology, The Alfred Hospital, Melbourne, Australia.,School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| |
Collapse
|