Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Vibeke Backer; Lars Olaf Cardell; Lauri Lehtimäki; Sanna Toppila-Salmi; Leif Bjermer; Sietze Reitsma; Peter W Hellings; Dan Weinfeld; Kasper Aanæs; Charlotte Suppli Ulrik; Gert-Jan Braunstahl; Bernt Bøgvald Aarli; Arild Danielsen; Hannu Kankaanranta; Sverre Steinsvåg; Claus Bachert

doi:10.3389/falgy.2023.1052386

Multidisciplinary approaches to identifying and managing global airways disease: Expert recommendations based on qualitative discussions

Front Allergy. 2023 Feb 21:4:1052386. doi: 10.3389/falgy.2023.1052386. eCollection 2023.

Authors

Vibeke Backer¹, Lars Olaf Cardell^{2

3}, Lauri Lehtimäki^{4

5}, Sanna Toppila-Salmi⁶, Leif Bjermer⁷, Sietze Reitsma⁸, Peter W Hellings^{8

9

10}, Dan Weinfeld¹¹, Kasper Aanæs¹, Charlotte Suppli Ulrik^{12

13}, Gert-Jan Braunstahl^{14

15}, Bernt Bøgvald Aarli^{16

17}, Arild Danielsen¹⁸, Hannu Kankaanranta^{5

19

20}, Sverre Steinsvåg²¹, Claus Bachert^{2

10

22}

Affiliations

¹ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark.
² Division of ENT Diseases, CLINTEC, Karolinska Institute, Stockholm, Sweden.
³ Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden.
⁴ Allergy Centre, Tampere University Hospital, Tampere, Finland.
⁵ Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
⁶ Department of Allergology, Skin and Allergy Hospital, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.
⁷ Department of Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden.
⁸ Department of Otorhinolaryngology - Head and Neck Surgery, Amsterdam University Medical Centers, Location AMC, Amsterdam, Netherlands.
⁹ Department of Otorhinolaryngology, University Hospitals Leuven, Leuven, Belgium.
¹⁰ Department of Otorhinolaryngology, Upper Airways Disease Research Group, University of Ghent, Ghent, Belgium.
¹¹ Asthma and Allergy Clinic Outpatient Unit (Adults), Department of Internal Medicine, South Alvsborgs Central Hospital, Boras, Sweden.
¹² Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark.
¹³ Institute of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
¹⁴ Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands.
¹⁵ Department of Pulmonology, Erasmus Medical Center, Rotterdam, Netherlands.
¹⁶ Department of Clinical Science, University of Bergen, Bergen, Norway.
¹⁷ Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway.
¹⁸ Department of ENT & Allergy, The Multidisciplinary Clinic "BestHelse", Oslo, Norway.
¹⁹ Department of Respiratory Medicine, Seinäjoki Central Hospital, Seinäjoki, Finland.
²⁰ Krefting Research Centre, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
²¹ Department of Otolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen and Sørlandet Sykehus, Kristiandsand, Norway.
²² Department of Otorhinolaryngology, International Airway Research Center, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.

Abstract

Background: Chronic rhinosinusitis with nasal polyps (CRSwNP) and asthma frequently co-exist and share pathologic features. Taking a "global" treatment approach benefits diagnosis and treatment of both, but care is often siloed by specialty: joined-up clinics are uncommon. Our objectives were to explore expert opinion to give practical suggestions to identify adults needing global airways care; enhance cross-specialty working; and widen knowledge to support diagnosis and management, integrate with existing care pathways, and supplement existing guidelines.

Methods: Sixteen practicing physicians from northern Europe were invited for their national and/or international standing in treating asthma and/or chronic rhinosinusitis. Appreciative Inquiry techniques were used to guide their discussions.

Results: Key themes arising were screening and referral, collaboration on management, awareness and education, and research. Provided are screening criteria and suggestions for specialist referrals, and pointers for physicians to optimize their knowledge of global airways disease. Collaborative working is underscored, and practical suggestions are given for multidisciplinary teamworking within global airways clinics. Research gaps are identified.

Conclusion: This initiative provides practical suggestions for optimizing the care of adults with CRSwNP and asthma. Discussion of the role of allergy and drug exacerbations on these conditions, and care for patients with other global airways diseases were beyond scope; however, we expect some principles of our discussion will likely benefit patients with related conditions. The suggestions bridge asthma and CRSwNP management guidelines, envisioning interdisciplinary, global airway clinics relevant to various clinical settings. They highlight the value of joint screening for early recognition and referral of patients.

Keywords: asthma; chronic rhinosinusitis with nasal polyps (CRSwNP); global airways disease; interdisciplinary care; nasal polyps; respiratory hypersensitivity; rhinitis; sinusitis.

Grants and funding

This study received funding from Sanofi. The funder participated in early discussions with the Chairs on the relevance and potential design of the project, but was not involved in the collection, analysis, or interpretation of data, the writing of this article, or the decision to submit it for publication. All authors declare no other competing interests.