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.
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.
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 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.
A physiotherapist can also provide benefit to patients through breathing training for dysfunctional breathing, pulmonary rehabilitation and mucus clearance techniques.
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.
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 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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