The core staff members required for a severe asthma clinic include a specialist asthma physician, a specialist asthma trained nurse and a pulmonary function scientist (McDonald et al. 2011, McDonald et al. 2017).
Core Staff
Physician
Specialist Nurse
Pulmonary Function Scientist
Physician
A physician with experience in the management of severe asthma provides an essential role in the identification/confirmation of a diagnosis, assessment of triggers and comorbidities and making treatment decisions for add-on therapies.
Specialist Nurse
A specialist nurse with extensive experience and skills related to chronic disease management and delivery of educational programmes is required. They assess asthma symptom control, lung function and inhaler technique. They can provide patients with education in self-management skills, including proper inhaler technique, self-monitoring and the use of a written action plan. An important role is the monitoring and coordination of treatment trials with add-on therapies. Further, a nurse can provide rapid access and telephone support during exacerbations and coordinate referrals and long-term management.
Pulmonary Function Scientist
A pulmonary function scientist is required to provide detailed assessments of patient’s lung function, including lung volumes, gas diffusion, respiratory pressure measurements, airway hyperresponsiveness testing, FeNO assessment and sputum inductions. These assessments are critical for detailed diagnosis and phenotyping of individuals with severe asthma.
Further Team Members
Further team members are necessary for multidisciplinary care, which may be present in the dedicated clinic or available through referral. This will depend on local resource and needs assessment.
Speech Pathologist
Dietitian
Physiotherapist
Psychologist
Additional Staffing for Comorbidity Management
Pharmacist
Administrative Support
Speech Pathologist
Vocal cord dysfunction (VCD) is a common comorbidity and differential diagnoses in people with severe asthma. An experienced speech pathologist with specialised skills in voice disorders can accurately assess and treat these conditions.
Dietitian
Obesity is also a common comorbidity, which contributes to increased asthma severity and impaired response to treatment. Patient access to a dietitian can provide nutritional assessment and interventions to reduce obesity. A physiotherapist may also be useful to advise on exercise-based interventions to improve fitness and reduce obesity.
Physiotherapist
A physiotherapist can also provide benefit to patients through breathing training for dysfunctional breathing, pulmonary rehabilitation and mucus clearance techniques.
Psychologist
Anxiety and depression are common in the severe asthma population. A psychologist can provide support in the assessment and diagnosis of mental health conditions.
Additional Staffing for Comorbidity Management
For other common comorbidities, access to sleep physicians (sleep disorder breathing), gastroenterologists (gastric oesophageal reflux disease) and/or otolaryngologist (rhinosinusitis, nasal polyps) can provide useful support for comorbidity management.
For more information on comorbidities related to severe asthma see Extrapulmonary comorbidities.
Pharmacist
A pharmacist is also required for the dispensing of the medication required by the severe asthma patient. Further, pharmacists support the severe asthma patient’s therapeutic regime by providing safe and appropriate access to medications, aligning with the best clinical evidence whilst respecting the patients’ values. Having pharmacists on a multidisciplinary team can improve the efficiency, effectiveness and quality of care delivered to patients with severe asthma.
Administrative Support
Administrative support is also critical to streamline referrals and appointment scheduling, to coordinate members of the multidisciplinary team and meetings and for ongoing quality improvement.
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