Interdisciplinary approaches help reduce asthma burden

Clinicians are encouraged to team with school employees, asthma educators and patient advocates to improve the health and well-being of patients with asthma, panelists said.

The speakers described three different interdisciplinary programs they spearhead during a symposium session of the American Academy of Allergy, Asthma and Immunology (AAAAI) Annual Meeting.

All three programs use evidence-based approaches and have been shown to improve asthma control while reducing health care utilization, according to AAAAI.

SAMPRO

Previous research indicates that collaborations between school health professionals and the health care system can improve the lives of children with asthma, according to Sujani Kakumanu, MD, FAAAAI, clinical associate professor of allergy and immunology at the University of Wisconsin School of Medicine and Public Health.

Sujani Kakumanu

Kakumanu, who is also a member of multiple AAAAI sections, boards and programs, participated in an AAAAI partnership with the National Association of School Nurses to launch the School-based Asthma Management Program, or SAMPRO, in 2016. Last year, the initiative was renamed School-based Asthma, Allergy & Anaphylaxis Management Program, or SA³MPRO, to reflect its extended purpose to help those with allergy and allergy-related emergencies, according to Kakumanu.

There are four components of SA³MPRO that aim to help schools and school nurses integrate within the asthma care team. These, Kakumanu said, include:

• “establishing and maintaining a healthy circle of support” that is centered around patients with asthma, allergies or anaphylaxis and their parents;
• developing action plans for each of these conditions that include details about the child, medication use and parental release of medically pertinent information;
• creating a “comprehensive education plan” for all school employees on the conditions; and
• developing ways to assess for and remediate school-based triggers of the conditions.

A SA³MPRO toolkit is available on AAAAI’s website. It contains specific recommendations for creating asthma, allergy and anaphylaxis action plans, involving school nurses in a patient’s care team, and using “breathmobile programs, school-based health centers and mobile clinics as important conduits of communication” between patients, their families, school nurses and other clinicians.

Kakumanu acknowledged that initiating school-based programs may be “daunting.” However, she noted that “partnerships amongst schools, families and clinicians can be powerful agents to improve the recognition of childhood asthma symptoms, asthma diagnosis and, in particular, management plans, emergency treatment plans and asthma action plans.”

IOEASMA

A program in Italy known as IOEASMA, which is Italian for “asthma and me,” has been successfully providing services for children with asthma for more than 20 years, according to Sebastiano Guarnaccia, MD, a pulmonology expert within the department of clinical and experimental sciences at Brescia University in Italy. The program uses an integrated approach where clinicians and asthma educators work together in a clinical setting to help children and adolescents bring their asthma under control.

Sebastiano Guarnaccia

Guarnaccia said in his AAAAI presentation that during clinical visits, IOEASMA participants receive educational booklets and CD-ROMs; localized guidelines that include information regarding asthma-related patient support; and access to a website “with dedicated areas for medical professionals, patients and families.” This information is supplemented by meetings with the educators, who discuss what happens during an asthma attack, and psychologists, who provide mental examinations of patients.

Data from a previous study coauthored by Guarnaccia showed that among 262 children who participated in IOESMA:

• 23% progressed from having “partially-controlled” to “well-controlled” asthma, and 17% progressed from “uncontrolled to “well-controlled” asthma;
• 8% were hospitalized for asthma before the program, 2% were hospitalized during the program and none were hospitalized at a 1-year follow-up visit; and
• 14% missed at least 1 day of school because of asthma before the IOESMA program compared with 4% during the program.

In the study, Guarnaccia and colleagues wrote that other clinicians can use IOEASMA as a springboard for creating similar programs, and that it “represents an innovative way of patient-centered care between primary physicians and specialists.”

EPAREC

Michiko Haida, MD, PhD, vice director of Hanuzoumon Hospital in Tokyo, discussed the Expert Patients in Respiratory Care (EPAREC) program in Japan. The course allows adults with long-standing asthma diagnoses to help patients with newly diagnosed asthma manage their condition.

Haida said EPAREC consists of:

• a pharmacist-led lecture that discusses proper inhaler use, allergens and asthma;
• a group learning session where students can ask questions and are tested on the pharmacist-led lecture; and
• classes where students hear from others who have had asthma for some time, review asthma guidelines and learn about other conditions that often occur concurrently with asthma, such as diabetes and hypertension.

“Although the asthma learning classes seems an ordinary learning class, it has many aspects which might enhance adherence to medication,” Haida continued.

Michiko Haika

According to Haida, newly diagnosed patients with asthma who have teamed with an EPAREC graduate have seen reductions in hospitalizations, ED visits, unscheduled clinician visits and missed days of school or work.

“We would like to propose a novel system of patient education by incorporating these findings and remodel the patient education system, so that the education itself will be truly helpful in raising [asthma medication] adherence and quality of life as well as reducing medical costs in the future,” Haida and colleagues wrote in an abstract submitted along with their AAAAI presentation.

References:

AAAAI. SAMPRO Summit Stakeholder Workforce. https://www.aaaai.org/Aaaai/media/MediaLibrary/PDF%20Documents/Libraries/SAMPRO-Summit-Stakeholder-Workforce.pdf. Accessed March 10, 2021.

AAAAI. School-based Asthma, Allergy and Anaphylaxis Management Program (SA³MPRO). https://www.aaaai.org/sampro. Accessed March 8, 2021.

AAAAI. School-based Asthma Management Program (SAMPRO) toolkit. Accessed March 8, 2021.

Guarnaccia S et al. A clinic-based program using a three-visit model assessment, tailored treatment and education in Italy. Presented at: American Academy of Allergy and Immunology Annual Meeting; February 26 - March 1, 2021 (virtual meeting).

Guaranaccia S, et al. Ital J Pediatr. 2017;doi:10.1186/s13052-017-0374-8.

Haida M, et al. A peer education program to improve asthma control in adults in Japan. Presented at: American Academy of Allergy and Immunology Annual Meeting; February 26 - March 1, 2021 (virtual meeting).

Haida M, et al. Assessment of patient assistance group, EPAREC, employing Asthma Beliefs and Medication Adherence (ABMA); A tool to assess behaviors necessary for self-management in asthma therapy. Accessed March 8, 2021.

Kakumanu S, et al. A school-based model that builds partnerships among schools, clinicians and families. Presented at: American Academy of Allergy and Immunology Annual Meeting; February 26 - March 1, 2021 (virtual meeting).