Publications by authors named "Ioanna Tsiligianni"

108 Publications

Artificial intelligence/machine learning in respiratory medicine and potential role in asthma and COPD diagnosis.

J Allergy Clin Immunol Pract 2021 Feb 19. Epub 2021 Feb 19.

Novartis Pharmaceuticals Corporation, East Hanover, USA.

Artificial intelligence (AI) and machine learning, a subset of AI, are increasingly utilized in medicine. AI excels at performing well-defined tasks, such as image recognition; for example, classifying skin biopsy lesions, determining diabetic retinopathy severity, and detecting brain tumors. This article provides an overview of the use of AI in medicine and particularly in respiratory medicine, where it is used to evaluate lung cancer images, diagnose fibrotic lung disease, and more recently is being developed to aid the interpretation of pulmonary function tests and the diagnosis of a range of obstructive and restrictive lung diseases. The development and validation of AI algorithms requires large volumes of well-structured data, and the algorithms must work with variable levels of data quality. It is important that clinicians understand how AI can function in the context of heterogeneous conditions such as asthma and COPD where diagnostic criteria overlap, how AI use fits into everyday clinical practice and how issues of patient safety should be addressed. AI has a clear role in providing support for doctors in the clinical workplace but its relatively recent introduction means that confidence in its use still has to be fully established. Overall, AI is expected to play a key role in aiding clinicians in the diagnosis and management of respiratory diseases in the future and it will be exciting to the see benefits that arise for patients and doctors from its use in everyday clinical practice.
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http://dx.doi.org/10.1016/j.jaip.2021.02.014DOI Listing
February 2021

Understanding what people think and feel about adult vaccinations and the associated barriers in Greece: Development and validation of the attitude towards adult vaccination (ATAVAC) scale.

Health Soc Care Community 2021 Feb 17. Epub 2021 Feb 17.

Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.

Despite the unequivocal value of vaccination in reducing the global burden of infectious diseases, the anti-vaccination movement thrives. The vast majority of the existing validated tools explore attitudes regarding vaccination in children. The aim of our study was to develop and validate a scale assessing attitudes towards adult immunisation. This national cross-sectional study included adult healthcare users who visited 23 Greek Primary Healthcare Units. The development of the scale was the result of literature review, semi-structured interviews and pilot testing of its preliminary versions. The initial version contained 15 items measuring respondents' attitudes on a 6-point Likert scale. The sample was randomly split into two halves. Exploratory factor analysis, performed in the first sample, was used for the creation of multi-item scales; confirmatory factor analysis was used in the second sample to assess goodness of fit. Moreover, concurrent validity, internal consistency reliability, test-retest reliability and ceiling and floor effects were explored. The total sample consisted of 1,571 individuals. Overall 'Cronbach's alpha' (0.821) indicated good internal consistency. The initial exploratory factor analysis resulted in a three-factor model. The subsequent confirmatory factor analysis indicated that an 11-item version of the scale provided the best fit of the model to the data (RMSEA = 0.050, SRMR = 0.053, TLI = 0.937, CFI = 0.955, AIC = 24,999.949). All subscales ('value of adult vaccination', 'safety concerns' and 'perceived barriers') demonstrated strong concurrent associations with participants' attitudes and behaviour regarding vaccination (p < .001). No ceiling or floor effects were noted for any of the subscales (0.13%, 2.61% and 0.51%; 0.13%, 0.57% and 0.45% respectively). The 11-item ATAVAC scale proved to be a reliable and valid tool, suitable for assessing attitudes towards adult vaccination.
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http://dx.doi.org/10.1111/hsc.13317DOI Listing
February 2021

A systematic approach to context-mapping to prepare for health interventions: development and validation of the SETTING-tool in four countries.

BMJ Glob Health 2021 Jan;6(1)

Public Health and Primary Care, Leiden University Medical Center, Leiden, the Netherlands.

Effectiveness of health interventions can be substantially impaired by implementation failure. Context-driven implementation strategies are critical for successful implementation. However, there is no practical, evidence-based guidance on how to map the context in order to design context-driven strategies. Therefore, this practice paper describes the development and validation of a systematic context-mapping tool. The tool was cocreated with local end-users through a multistage approach. As proof of concept, the tool was used to map beliefs and behaviour related to chronic respiratory disease within the FRESH AIR project in Uganda, Kyrgyzstan, Vietnam and Greece. Feasibility and acceptability were evaluated using the modified Conceptual Framework for Implementation Fidelity. Effectiveness was assessed by the degree to which context-driven adjustments were made to implementation strategies of FRESH AIR health interventions. The resulting Setting-Exploration-Treasure-Trail-to-Inform-implementatioN-strateGies (SETTING-tool) consisted of six steps: (1) Coset study priorities with local stakeholders, (2) Combine a qualitative rapid assessment with a quantitative survey (a mixed-method design), (3) Use context-sensitive materials, (4) Collect data involving community researchers, (5) Analyse pragmatically and/or in-depth to ensure timely communication of findings and (6) Continuously disseminate findings to relevant stakeholders. Use of the tool proved highly feasible, acceptable and effective in each setting. To conclude, the SETTING-tool is validated to systematically map local contexts for (lung) health interventions in diverse low-resource settings. It can support policy-makers, non-governmental organisations and health workers in the design of context-driven implementation strategies. This can reduce the risk of implementation failure and the waste of resource potential. Ultimately, this could improve health outcomes.
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http://dx.doi.org/10.1136/bmjgh-2020-003221DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7805378PMC
January 2021

GINA 2020: Potential Impacts, Opportunities and Challenges for Primary Care.

J Allergy Clin Immunol Pract 2020 Dec 26. Epub 2020 Dec 26.

Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia. Electronic address:

In 2019, it was reported that changes to asthma management reported in the Global Initiative for Asthma (GINA) "…might be considered the most fundamental changes in asthma management in 30 years." These changes refer to the recommendation that the treatment of asthma in adolescents and adults would no longer include short-acting ß-agonist (SABA) only, but that people with asthma should receive either symptom-driven inhaled corticosteroids (ICS)-containing treatment (mild asthma) or daily ICS-containing treatment. The fundamental reason for this shift was driven by concerns about the risks and consequences associated with SABA-only treatment, the need to improve the day-to-day management of asthma symptoms to prevent exacerbations and emergent evidence. These recommendations have subsequently been reinforced and characterized in GINA 2020, and it is reasonable to say that they are significant, not only in terms of an asthma management framework but also as a management approach in practice. This opinion article specifically focuses on opportunities and challenges associated with the implementation of GINA 2020 in primary care practice that need to be recognized and addressed if the shift in asthma treatment paradigm is to be successfully implemented into day-to-day practice.
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http://dx.doi.org/10.1016/j.jaip.2020.12.035DOI Listing
December 2020

Tiotropium/Olodaterol Delays Clinically Important Deterioration Compared with Tiotropium Monotherapy in Patients with Early COPD: a Post Hoc Analysis of the TONADO Trials.

Adv Ther 2021 01 11;38(1):579-593. Epub 2020 Nov 11.

Respiratory Division, National Heart and Lung Institute, Imperial College London, London, UK.

Introduction: Since chronic obstructive pulmonary disease (COPD) is a heterogeneous condition, a composite endpoint of clinically important deterioration (CID) may provide a more holistic assessment of treatment efficacy. We compared long-acting muscarinic antagonist/long-acting β-agonist combination therapy with tiotropium/olodaterol versus tiotropium alone using a composite endpoint for CID. CID was evaluated overall and in patients with low exacerbation history (at most one moderate exacerbation in the past year [not leading to hospitalisation]), Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2 patients and maintenance-naïve patients with COPD. We assessed whether early treatment optimisation is more effective with tiotropium/olodaterol versus tiotropium in delaying and reducing the risk of CID.

Methods: Data were analysed from 2055 patients treated with either tiotropium/olodaterol 5/5 μg or tiotropium 5 μg (delivered via Respimat) in two replicate, 52-week, parallel-group, double-blind studies (TONADO 1/2). CID was defined as a decline of at least 0.1 L from baseline in trough forced expiratory volume in 1 s, increase from baseline of at least 4 units in St. George's Respiratory Questionnaire score, or moderate/severe exacerbation. Time to first occurrence of one of these events was recorded as time to first CID.

Results: Overall, treatment with tiotropium/olodaterol significantly increased the time to, and reduced the risk of, CID versus tiotropium (median time to CID 226 versus 169 days; hazard ratio [HR] 0.76 [95% confidence interval 0.68, 0.85]; P < 0.0001). Significant reductions were also observed in patients with low exacerbation history (241 versus 170; HR 0.73 [0.64, 0.83]; P < 0.0001), GOLD 2 patients (241 versus 169; 0.72 [0.61, 0.84]; P < 0.0001) and maintenance-naïve patients (233 versus 171; 0.75 [0.62, 0.91]; P = 0.0030).

Conclusion: In patients with COPD, including patients with low exacerbation history, GOLD 2 patients and maintenance-naïve patients, tiotropium/olodaterol reduced the risk of CID versus tiotropium. These results demonstrate the advantages of treatment optimisation with tiotropium/olodaterol over tiotropium monotherapy.

Trial Registration: ClinicalTrials.gov identifier: TONADO 1 and 2 (NCT01431274 and NCT01431287, registered 8 September 2011).
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http://dx.doi.org/10.1007/s12325-020-01528-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7854451PMC
January 2021

Adherence to inhalers and comorbidities in COPD patients. A cross-sectional primary care study from Greece.

BMC Pulm Med 2020 Sep 25;20(1):253. Epub 2020 Sep 25.

Health Planning Unit. Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, Heraklion, GR-71003, Crete, Greece.

Background: Comorbidities and adherence to inhaled therapy appears to have a major impact on treatment goals, health status and disease control in chronic obstructive pulmonary disease (COPD). Aim of the study was to assess levels of adherence to inhalers, comorbidities and associations with COPD outcomes in patients residing in rural and semi-urban areas of Greece.

Methods: Two hundred fifty-seven COPD patients were enrolled from primary health care in 2015-2016. Physicians used structured interviews and questionnaires to assess quality of life and disease status. Patients were classified into groups according to GOLD 2019 guidelines (based on CAT and mMRC). Adherence to inhalers was measured with the Test of Adherence to Inhalers (TAI). Multivariate linear and logistics regression models were used to assess associations between comorbidities and adherence to inhalers with COPD outcomes, including CAT and mMRC scores, exacerbations and GOLD A-D status.

Results: 74.1% of COPD patients reported poor adherence, while most of them were characterized as deliberate non-compliers (69.5%). 77.1% had ≥2 comorbidities, with overweight/obese (82.2%), hypertension (72.9%) and diabetes mellitus (58%) being the most prevalent. In multivariate analysis, COPD outcomes having significant associations with poor adherence included worse health status [OR (95% CI) 4.86 (1.61-14.69) and 2.93 (1.51-5.71) based on CAT and mMRC, respectively], having ≥2 exacerbations in the past year [4.68 (1.51-4.44)], and disease status e.g., be in groups C or D [3.13 (1.49-8.53) and 3.35 (1.24-9.09) based on CAT and mMRC, respectively). Subjects with gastroesophageal reflux showed better inhaler adherence [OR (95% CI) 0.17 (0.6-0.45)], but none of the comorbid conditions was associated with COPD outcomes after adjustments.

Conclusions: Poor adherence to inhalers and comorbidities are both prevalent in COPD patients of primary care residing in rural/semi-urban areas of Greece, with adherence influencing COPD outcomes. Raising awareness of patients and physicians on the importance of comorbidities control and inhaler adherence may lead to interventions and improve outcomes.
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http://dx.doi.org/10.1186/s12890-020-01296-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7519509PMC
September 2020

Cognitive impairment in a primary healthcare population: a cross-sectional study on the island of Crete, Greece.

BMJ Open 2020 09 24;10(9):e035551. Epub 2020 Sep 24.

Clinic of Social and Family Medicine, University of Crete Faculty of Medicine, Heraklion, Greece.

Objectives: Cognitive impairment is known to have a significant impact on the quality of life of individuals and their caregivers, yet it is often underdiagnosed. The objective of this study is to assess the extent of cognitive impairment among elders visiting primary healthcare (PHC) practice settings, to explore associated risk factors and discuss current care challenges for PHC providers.

Design: A cross-sectional study was conducted between March 2013 and May 2014.

Setting: Fourteen PHC units located in rural and urban areas of the Heraklion district in Crete, Greece.

Participants: Consecutive visitors aged at least 60 years attending selected PHC practices.

Primary And Secondary Outcome Measures: The Mini-Mental State Examination (MMSE) was used to indicate cognitive status. Associations of low MMSE scores (≤23/24, adjusted for education level) with 12 socio-demographic factors, comorbidities and lifestyle factors were assessed.

Results: A total of 3140 PHC patients met inclusion criteria (43.2% male; mean age 73.7±7.8 years). The average MMSE score was 26.0±3.8; 26.7±3.5 in male and 25.4±3.9 in female participants (p<0.0001). Low MMSE scores were detected in 20.2% of participants; 25.9% for females vs 12.8% for males; p<0.0001. Female gender (adjusted OR (AOR)=2.72; 95% CI 2.31 to 3.47), age (AOR=1.11; 95% CI 1.10 to 1.13), having received only primary or no formal education (AOR=2.87; 95% CI 2.26 to 3.65), alcohol intake (AOR=1.19; 95% CI 1.03 to 1.37), reporting one or more sleep complaints (AOR 1.63; 95% CI 1.14 to 2.32), dyslipidaemia (AOR=0.80; 95% CI 0.65 to 0.98) and history of depression (AOR=1.90; 95% CI 1.43 to 2.52) were associated with low MMSE scores.

Conclusions: This study identified a relatively high prevalence of low MMSE scores among persons attending PHC practices in a southern European community setting and associations with several known risk factors.
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http://dx.doi.org/10.1136/bmjopen-2019-035551DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7517574PMC
September 2020

Exploring primary care physician experiences conducting practice-based research on adult vaccination: a qualitative evaluation study in Greece.

Fam Pract 2020 Nov;37(6):828-833

Research Committee of Greek Association of General Practitioners, Thessaloniki, Greece.

Background: Research in primary care is necessary to empower its role in health systems and improve population health.

Objective: The aim of this evaluation study was to assess the experiences of primary care physicians who participated as researchers in a multi-centre, mixed-methodology study on adult vaccination supported by a newly established practice-based research network.

Methods: Twenty-three physicians participated as researchers, operating in their own practices in 10 different prefectures of Greece. After the completion of the study, they were asked to reflect on their experiences in the research by providing written responses to the questions on the evaluation tool of the study. The open-ended questions were analyzed using thematic content analysis.

Results: Mean age of the researchers was 42.9 years old (±3.9, min 35, max 49) and 11 (47.8%) were male. Six themes emerged as beneficial for the participating researchers: (i) raised awareness of patients' needs, (ii) enhancement of clinical practice and services offered, (iii) positive impact on the doctor-patient relationship, (iv) personal satisfaction, (v) enrichment of their curriculum vitae and (vi) improvement of research skills. All researchers were interested in participating in future studies.

Conclusion: The experience of conducting clinical research on adult vaccination in their own practices within a network was reported to be very rewarding. The benefits gained from their participation could be a valuable tool in promoting research and enhancing the quality of primary health care.
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http://dx.doi.org/10.1093/fampra/cmaa063DOI Listing
November 2020

Modeling patients' choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis.

Prim Care Diabetes 2021 Feb 5;15(1):150-155. Epub 2020 Aug 5.

Research Committee of Greek Association of General Practitioners, 54625 Thessaloniki, Greece; Department of Social Medicine, Faculty of Medicine, University of Crete, 71003 Heraklion Crete, Greece. Electronic address:

Aims: To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice.

Methods: This cross-sectional study was conducted in nine Greek primary healthcare units. Patients' choices were modeled using a bivariate probit analysis.

Results: A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p=0.033 or currently p=0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p=0.040), female sex (p=0.017), higher HbA1c (p=0.004), experience of hypoglycemia (p=0.029) and low cardiovascular morbidity index (p=0.016) emerged as important predictors for choosing a diabetes specialist for their treatment.

Conclusions: Our findings provide a better insight in diabetes patients' choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists' guidance.
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http://dx.doi.org/10.1016/j.pcd.2020.07.010DOI Listing
February 2021

Respiratory research funding is inadequate, inequitable, and a missed opportunity.

Lancet Respir Med 2020 08;8(8):e67-e68

Department of International Public Health, Liverpool School of Tropical Medicine, Liverpool, UK.

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http://dx.doi.org/10.1016/S2213-2600(20)30329-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7402663PMC
August 2020

Respiratory health in Greece.

Lancet Respir Med 2020 07;8(7):e65-e66

Assistant Professor, Faculty of Medicine, University of Crete, Greece. Electronic address:

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http://dx.doi.org/10.1016/S2213-2600(20)30276-9DOI Listing
July 2020

Vitamin D deficiency in patients evaluated for obstructive sleep apnea: is it associated with disease severity?

Sleep Breath 2020 Jul 10. Epub 2020 Jul 10.

Sleep Disorders Center, Department of Respiratory Medicine, School of Medicine, University of Crete, Voutes Campus, GR-71003, Heraklion, Crete, Greece.

Purpose: The aim of the present study was to assess vitamin D levels in a large cohort of OSA patients and to investigate possible correlations with clinical and polysomnographic parameters.

Methods: In this cross-sectional study, 685 consecutive patients underwent type 1 polysomnography (PSG) for OSA diagnosis. They were grouped according to apnea-hypopnea index (AHI) as mild, moderate, and severe. Patients with AHI < 5 served as controls. Demographic, PSG data, and serum levels of vitamin D were measured and compared between groups.

Results: OSA was diagnosed in 617 of the patients (90%). Of those, 94 (15%) had mild OSA, 150 (24%) moderate OSA, and 373 (61%) severe OSA. The risk of vitamin D deficiency (< 20 ng/mL) was observed in 38% of the cohort. OSA patients had lower vitamin D levels compared to controls (23 ng/mL vs 26 ng/mL, p = 0.006). The lowest levels of vitamin D [mean 21] (p < 0.001 among all groups) and the higher prevalence for vitamin D deficiency (45%) were observed in severe OSA patients. After multiparametric adjustments for age, gender, obesity, and comorbidities, severe OSA showed significant independent associations with the risk of vitamin D deficiency [OR (95% CI) 2.002 (1.049-3.819), p = 0.035].

Conclusions: A large proportion of patients referred for OSA evaluation had vitamin D deficiency, which was independently associated with severe OSA. However, further research is needed in order to determine the role of vitamin D in OSA patients.
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http://dx.doi.org/10.1007/s11325-020-02142-wDOI Listing
July 2020

ARIA-EAACI statement on asthma and COVID-19 (June 2, 2020).

Authors:
Jean Bousquet Marek Jutel Cezmi A Akdis Ludger Klimek Oliver Pfaar Kari C Nadeau Thomas Eiwegger Anna Bedbrook Ignacio J Ansotegui Josep M Anto Claus Bachert Eric D Bateman Kazi S Bennoor Elena Camelia Berghea Karl-Christian Bergmann Hubert Blain Mateo Bonini Sinthia Bosnic-Anticevich Louis-Philippe Boulet Luisa Brussino Roland Buhl Paulo Camargos Giorgio Walter Canonica Victoria Cardona Thomas Casale Sharon Chinthrajah Mübeccel Akdis Tomas Chivato George Christoff Alvaro A Cruz Wienczyslawa Czarlewski Stefano Del Giacco Hui Du Yehia El-Gamal Wytske J Fokkens Joao A Fonseca Yadong Gao Mina Gaga Bilun Gemicioglu Maia Gotua Tari Haahtela David Halpin Eckard Hamelmann Karin Hoffmann-Sommergruber Marc Humbert Nataliya Ilina Juan-Carlos Ivancevich Guy Joos Musa Khaitov Bruce Kirenga Edward F Knol Fanny W Ko Seppo Koskinen Marek L Kowalski Helga Kraxner Dmitry Kudlay Piotr Kuna Maciej Kupczyk Violeta Kvedariene Amir H Abdul Latiff Lan T Le Michael Levin Desiree Larenas-Linnemann Renaud Louis Mohammad R Masjedi Erik Melén Florin Mihaltan Branislava Milenkovic Yousser Mohammad Mario Morais-Almeida Joaquim Mullol Leyla Namazova Hugo Neffen Elisabete Nunes Paul O'Byrne Robyn O'Hehir Liam O'Mahony Ken Ohta Yoshitaka Okamoto Gabrielle L Onorato Petr Panzner Nikos G Papadopoulos Gianni Passalacqua Vincenzo Patella Ruby Pawankar Nhân Pham-Thi Bernard Pigearias Todor A Popov Francesca Puggioni Frederico S Regateiro Giovanni Rolla Menachem Rottem Boleslaw Samolinski Joaquin Sastre Jurgen Schwarze Aziz Sheikh Nicola Scichilone Manuel Soto-Quiros Manuel Soto-Martinez Milan Sova Stefania Nicola Rafael Stelmach Charlotte Suppli-Ulrik Luis Taborda-Barata Teresa To Peter-Valentin Tomazic Sanna Toppila-Salmi Ioanna Tsiligianni Omar Usmani Arunas Valiulis Maria Teresa Ventura Giovanni Viegi Theodor Vontetsianos De Yun Wang Sian Williams Gary W K Wong Arzu Yorgancioglu Mario Zernotti Mihaela Zidarn Torsten Zuberbier Ioana Agache

Allergy 2020 Jun 26. Epub 2020 Jun 26.

Transylvania University Brasov, Brasov, Romania.

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http://dx.doi.org/10.1111/all.14471DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7361514PMC
June 2020

Associations of sense of coherence and self-efficacy with health status and disease severity in COPD.

NPJ Prim Care Respir Med 2020 06 18;30(1):27. Epub 2020 Jun 18.

Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Herkalion, Crete, Greece.

Sense of coherence and self-efficacy has been found to affect health-related quality of life in chronic diseases. However, research on respiratory diseases is limited. Here we report findings on quality of life (QoL) of COPD patients and the associations with coherence and self-efficacy. This study consists of the Greek national branch of the UNLOCK study, with a sample of 257 COPD patients. Coherence and self-efficacy are positively inter-correlated (Pearson rho = 0.590, p < 0.001). They are negatively correlated with the quality of life (CAT) [Pearson rho: coherence = -0.29, p < 0.001; self-efficacy = -0.29, p < 0.001) and mMRC (coherence = -0.37, p < 0.001; self-efficacy rho = -0.32, p < 0.001)]. Coherence is inversely associated with (Global Initiative for Chronic Obstructive Lung Disease) GOLD 2018-CAT and GOLD 2018-mMRC classification and "having at least one exacerbation in the past year". Findings are stressing the need for their incorporation in primary health care and COPD guidance as it maybe that enhancing coherence and self-efficacy will improve QoL.
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http://dx.doi.org/10.1038/s41533-020-0183-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303183PMC
June 2020

Improving primary care management of asthma: do we know what really works?

NPJ Prim Care Respir Med 2020 06 17;30(1):29. Epub 2020 Jun 17.

Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

Asthma imposes a substantial burden on individuals and societies. Patients with asthma need high-quality primary care management; however, evidence suggests the quality of this care can be highly variable. Here we identify and report factors contributing to high-quality management. Twelve primary care global asthma experts, representing nine countries, identified key factors. A literature review (past 10 years) was performed to validate or refute the expert viewpoint. Key driving factors identified were: policy, clinical guidelines, rewards for performance, practice organisation and workforce. Further analysis established the relevant factor components. Review evidence supported the validity of each driver; however, impact on patient outcomes was uncertain. Single interventions (e.g. healthcare practitioner education) showed little effect; interventions driven by national policy (e.g. incentive schemes and teamworking) were more effective. The panel's opinion, supported by literature review, concluded that multiple primary care interventions offer greater benefit than any single intervention in asthma management.
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http://dx.doi.org/10.1038/s41533-020-0184-0DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7300034PMC
June 2020

COVID-19 poses novel challenges for global primary care.

NPJ Prim Care Respir Med 2020 06 18;30(1):30. Epub 2020 Jun 18.

International Primary Care Respiratory Group (IPCRG), London, UK.

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http://dx.doi.org/10.1038/s41533-020-0187-xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7303134PMC
June 2020

ARIA digital anamorphosis: Digital transformation of health and care in airway diseases from research to practice.

Authors:
Jean Bousquet Josep M Anto Claus Bachert Tari Haahtela Torsten Zuberbier Wienczyslawa Czarlewski Anna Bedbrook Sinthia Bosnic-Anticevich G Walter Canonica Victoria Cardona Elisio Costa Alvaro A Cruz Marina Erhola Wytske J Fokkens Joao A Fonseca Maddalena Illario Juan-Carlos Ivancevich Marek Jutel Ludger Klimek Piotr Kuna Violeta Kvedariene Ltt Le Désirée E Larenas-Linnemann Daniel Laune Olga M Lourenço Erik Melén Joaquim Mullol Marek Niedoszytko Mikaëla Odemyr Yoshitaka Okamoto Nikos G Papadopoulos Vincenzo Patella Oliver Pfaar Nhân Pham-Thi Christine Rolland Boleslaw Samolinski Aziz Sheikh Mikhail Sofiev Charlotte Suppli Ulrik Ana Todo-Bom Peter-Valentin Tomazic Sanna Toppila-Salmi Ioanna Tsiligianni Arunas Valiulis Erkka Valovirta Maria-Teresa Ventura Samantha Walker Sian Williams Arzu Yorgancioglu Ioana Agache Cezmi A Akdis Rute Almeida Ignacio J Ansotegui Isabella Annesi-Maesano Sylvie Arnavielhe Xavier Basagaña Eric D Bateman Annabelle Bédard Martin Bedolla-Barajas Sven Becker Kazi S Bennoor Samuel Benveniste Karl C Bergmann Michael Bewick Slawomir Bialek Nils E Billo Carsten Bindslev-Jensen Leif Bjermer Hubert Blain Matteo Bonini Philippe Bonniaud Isabelle Bosse Jacques Bouchard Louis-Philippe Boulet Rodolphe Bourret Koen Boussery Fluvio Braido Vitalis Briedis Andrew Briggs Christopher E Brightling Jan Brozek Guy Brusselle Luisa Brussino Roland Buhl Roland Buonaiuto Moises A Calderon Paulo Camargos Thierry Camuzat Luis Caraballo Ana-Maria Carriazo Warner Carr Christine Cartier Thomas Casale Lorenzo Cecchi Alfonso M Cepeda Sarabia Niels H Chavannes Ekaterine Chkhartishvili Derek K Chu Cemal Cingi Jaime Correia de Sousa David J Costa Anne-Lise Courbis Adnan Custovic Biljana Cvetkosvki Gennaro D'Amato Jane da Silva Carina Dantas Dejan Dokic Yves Dauvilliers Giulia De Feo Govert De Vries Philippe Devillier Stefania Di Capua Gerard Dray Ruta Dubakiene Stephen R Durham Mark Dykewicz Motohiro Ebisawa Mina Gaga Yehia El-Gamal Enrico Heffler Regina Emuzyte John Farrell Jean-Luc Fauquert Alessandro Fiocchi Antje Fink-Wagner Jean-François Fontaine José M Fuentes Perez Bilun Gemicioğlu Amiran Gamkrelidze Judith Garcia-Aymerich Philippe Gevaert René Maximiliano Gomez Sandra González Diaz Maia Gotua Nick A Guldemond Maria-Antonieta Guzmán Jawad Hajjam Yunuen R Huerta Villalobos Marc Humbert Guido Iaccarino Despo Ierodiakonou Tomohisa Iinuma Ewa Jassem Guy Joos Ki-Suck Jung Igor Kaidashev Omer Kalayci Przemyslaw Kardas Thomas Keil Musa Khaitov Nikolai Khaltaev Jorg Kleine-Tebbe Rostislav Kouznetsov Marek L Kowalski Vicky Kritikos Inger Kull Stefania La Grutta Lisa Leonardini Henrik Ljungberg Philip Lieberman Brian Lipworth Karin C Lodrup Carlsen Catarina Lopes-Pereira Claudia C Loureiro Renaud Louis Alpana Mair Bassam Mahboub Michaël Makris Joao Malva Patrick Manning Gailen D Marshall Mohamed R Masjedi Jorge F Maspero Pedro Carreiro-Martins Mika Makela Eve Mathieu-Dupas Marcus Maurer Esteban De Manuel Keenoy Elisabete Melo-Gomes Eli O Meltzer Enrica Menditto Jacques Mercier Yann Micheli Neven Miculinic Florin Mihaltan Branislava Milenkovic Dimitirios I Mitsias Giuliana Moda Maria-Dolores Mogica-Martinez Yousser Mohammad Steve Montefort Ricardo Monti Mario Morais-Almeida Ralph Mösges Lars Münter Antonella Muraro Ruth Murray Robert Naclerio Luigi Napoli Leyla Namazova-Baranova Hugo Neffen Kristoff Nekam Angelo Neou Björn Nordlund Ettore Novellino Dieudonné Nyembue Robyn O'Hehir Ken Ohta Kimi Okubo Gabrielle L Onorato Valentina Orlando Solange Ouedraogo Julia Palamarchuk Isabella Pali-Schöll Peter Panzner Hae-Sim Park Gianni Passalacqua Jean-Louis Pépin Ema Paulino Ruby Pawankar Jim Phillips Robert Picard Hilary Pinnock Davor Plavec Todor A Popov Fabienne Portejoie David Price Emmanuel P Prokopakis Fotis Psarros Benoit Pugin Francesca Puggioni Pablo Quinones-Delgado Filip Raciborski Rojin Rajabian-Söderlund Frederico S Regateiro Sietze Reitsma Daniela Rivero-Yeverino Graham Roberts Nicolas Roche Erendira Rodriguez-Zagal Christine Rolland Regina E Roller-Wirnsberger Nelson Rosario Antonino Romano Menachem Rottem Dermot Ryan Johanna Salimäki Mario M Sanchez-Borges Joaquin Sastre Glenis K Scadding Sophie Scheire Peter Schmid-Grendelmeier Holger J Schünemann Faradiba Sarquis Serpa Mohamed Shamji Juan-Carlos Sisul Mikhail Sofiev Dirceu Solé David Somekh Talant Sooronbaev Milan Sova François Spertini Otto Spranger Cristiana Stellato Rafael Stelmach Michel Thibaudon Teresa To Mondher Toumi Omar Usmani Antonio A Valero Rudolph Valenta Marylin Valentin-Rostan Marilyn Urrutia Pereira Rianne van der Kleij Michiel Van Eerd Olivier Vandenplas Tuula Vasankari Antonio Vaz Carneiro Giorgio Vezzani Frédéric Viart Giovanni Viegi Dana Wallace Martin Wagenmann De Yun Wang Susan Waserman Magnus Wickman Dennis M Williams Gary Wong Piotr Wroczynski Panayiotis K Yiallouros Osman M Yusuf Heather J Zar Stéphane Zeng Mario E Zernotti Luo Zhang Nan Shan Zhong Mihaela Zidarn

Allergy 2021 01 23;76(1):168-190. Epub 2020 Oct 23.

University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.

Digital anamorphosis is used to define a distorted image of health and care that may be viewed correctly using digital tools and strategies. MASK digital anamorphosis represents the process used by MASK to develop the digital transformation of health and care in rhinitis. It strengthens the ARIA change management strategy in the prevention and management of airway disease. The MASK strategy is based on validated digital tools. Using the MASK digital tool and the CARAT online enhanced clinical framework, solutions for practical steps of digital enhancement of care are proposed.
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http://dx.doi.org/10.1111/all.14422DOI Listing
January 2021

Corrigendum to "A review of the burden and management of mild asthma in adults - Implications for clinical practice" [Respir. Med. 152 (2019) 97-104].

Respir Med 2020 Apr - May;165:105872. Epub 2020 Jan 24.

Department of Social Medicine, Faculty of Medicine, University of Crete, Heraklion, Crete, Voutes, GR71003, Greece.

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http://dx.doi.org/10.1016/j.rmed.2020.105872DOI Listing
January 2020

Research Priorities in Pediatric Asthma: Results of a Global Survey of Multiple Stakeholder Groups by the Pediatric Asthma in Real Life (PeARL) Think Tank.

J Allergy Clin Immunol Pract 2020 06 4;8(6):1953-1960.e9. Epub 2020 Mar 4.

Division of Infection, Immunity and Respiratory Medicine, School of Biological Sciences, The University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Paediatric Clinic, National and Kapodistrian University of Athens, Athens, Greece. Electronic address:

Background: Pediatric asthma remains a public health challenge with enormous impact worldwide.

Objective: The aim of this study was to identify and prioritize unmet clinical needs in pediatric asthma, which could be used to guide future research and policy activities.

Methods: We first identified unmet needs through an open-question survey administered to international experts in pediatric asthma who were members of the Pediatric Asthma in Real Life Think Tank. Prioritization of topics was then achieved through a second, extensive survey with global reach, of multiple stakeholders (leading experts, researchers, clinicians, patients, policy makers, and the pharmaceutical industry). Differences across responder groups were compared.

Results: A total of 57 unmet clinical need topics identified by international experts were prioritized by 412 participants from 5 continents and 60 countries. Prevention of disease progression and prediction of future risk, including persistence into adulthood, emerged as the most urgent research questions. Stratified care, based on biomarkers, clinical phenotypes, the children's age, and demographics were also highly rated. The identification of minimum diagnostic criteria in different age groups, cultural perceptions of asthma, and best treatment by age group were priorities for responders from low-middle-income countries. There was good agreement across different stakeholder groups in all domains with some notable exceptions that highlight the importance of involving the whole range of stakeholders in formulation of recommendations.

Conclusions: Different stakeholders agree in the majority of research and strategic (eg, prevention, personalized approach) priorities for pediatric asthma. Stakeholder diversity is crucial for highlighting divergent issues that future guidelines should consider.
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http://dx.doi.org/10.1016/j.jaip.2020.01.059DOI Listing
June 2020

Subjective sleep quality is associated with disease status in COPD patients. The cross-sectional Greek UNLOCK study.

Sleep Breath 2020 Dec 26;24(4):1599-1605. Epub 2020 Feb 26.

Health Planning Unit, Department of Social Medicine, Faculty of Medicine, University of Crete, Voutes Campus, GR-71003, Heraklion, Crete, Greece.

Purpose: The association of chronic obstructive pulmonary disease (COPD) severity and related health status with sleep quality remains unclear. We aimed to investigate the association between COPD and sleep quality in the Greek national branch of the UNLOCK cohort.

Methods: A sample of 257 COPD patients enrolled cross-sectionally from primary care in Greece. Sleep quality was assessed by the COPD and Asthma Sleep Impact Scale (CASIS-7 items) questionnaire (higher score indicates worse sleep quality). We tested for associations of sleep impairment with health status (CAT and mMRC scores), exacerbations, hospitalizations, GOLD 2018 ABCD status, inhaler adherence, frailty, and sense of coherence, adjusting for age, gender, smoking status, and comorbidities.

Results: The majority of patients reported uncontrolled symptoms (91% with ≥ 10 CAT or 61% with ≥ 2 mMRC). Mean (SD) age was 65 (12.3) with 79% males. CASIS-7 mean (SD) score was 37.7 (12.9). After adjustments, CASIS was significantly associated with worse health status (e.g., CASIS increased with CAT ≥ 10 [β = 12.53, (95% CI, 6.82, 18.25); p < 0.001], mMRC ≥ 2 [β = 4.96, (95% CI, 1.56, 8.34); p = 0.004]), COPD severity (CAT-based GOLD BD [β = 8.88 (95% CI, 2.50, 15.26); p = 0.007]), frailty [β = 8.85 (95% CI 4.45,13.25); p < 0.001], and sense of coherence [β = -0.14 (95% CI -0.21, -0.06), p < 001]. When using a CASIS cut-off score of 30 as indicator of sleep impairment, additional to the aforementioned associations, we found increased risk for sleep impairment with ≥ 2 exacerbations/year and poor inhaler adherence (p value < 0.05).

Conclusions: Our study suggests that worse health status and COPD severity are associated with poor sleep quality in COPD patients.
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http://dx.doi.org/10.1007/s11325-020-02039-8DOI Listing
December 2020

Daytime symptoms of chronic obstructive pulmonary disease: a systematic review.

NPJ Prim Care Respir Med 2020 02 21;30(1). Epub 2020 Feb 21.

Groningen Research Institute for Asthma and COPD (GRIAC), University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.

There is no single source of compiled data on symptoms experienced by patients with chronic obstructive pulmonary disease (COPD) when awake and active throughout the day. The aim of this systematic review was to evaluate the prevalence, variability, and burden (i.e., bothersomeness and/or intensity), and the impact of daytime COPD symptoms on other outcomes. The review also evaluated the impact of interventions and the measures/tools used to assess daytime COPD symptoms in patients. A systematic literature search was conducted using the primary search terms "COPD", "symptoms", and "daytime" in EMBASE®, MEDLINE®, MEDLINE® In-Process, and CENTRAL in 2016, followed by an additional search in 2018 to capture any new literature that was published since the last search. Fifty-six articles were included in the review. The accumulated evidence indicated that the symptomatic burden of COPD appears greatest in the morning, particularly upon waking, and that these morning symptoms have a substantial impact on patients' ability to function normally through the day; they also worsen quality of life. A wide variety of tools were used to evaluate symptoms across the studies. The literature also confirmed the importance of pharmacotherapy in the management of daytime COPD symptoms, and in helping normalize daily functioning. More research is needed to better understand how COPD symptoms impact daily functioning and to evaluate COPD symptoms at well-defined periods throughout the day, using validated and uniform measures/tools. This will help clinicians to better define patients' needs and take appropriate action.
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http://dx.doi.org/10.1038/s41533-020-0163-5DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7035364PMC
February 2020

Assessment of obstructive sleep apnoea in primary care: Screening and evaluation strategies.

Int J Clin Pract 2020 05 11;74(5):e13482. Epub 2020 Feb 11.

Sleep Disorders Center, Department of Thoracic Medicine, University of Crete, Heraklion, Greece.

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http://dx.doi.org/10.1111/ijcp.13482DOI Listing
May 2020

Gender differences among Swedish COPD patients: results from the ARCTIC, a real-world retrospective cohort study.

NPJ Prim Care Respir Med 2019 12 10;29(1):45. Epub 2019 Dec 10.

Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.

The present study aimed to generate real-world evidence regarding gender differences among chronic obstructive pulmonary disease (COPD) patients, especially as regards the diagnosis and outcomes in order to identify areas for improvement and management and optimize the associated healthcare resource allocation. ARCTIC is a large, real-world, retrospective cohort study conducted in Swedish COPD patients and a matched reference population from 52 primary care centers in 2000-2014. The incidence of COPD, prevalence of asthma and other comorbidities, risk of exacerbations, mortality rate, COPD drug prescriptions, and healthcare resource utilization were analyzed. In total, 17,479 patients with COPD were included in the study. During the study period, COPD was more frequent among women (53.8%) and women with COPD experienced more exacerbations vs. men (6.66 vs. 4.66). However, the overall mortality rate was higher in men compared with women (45% vs. 38%), but no difference for mortality due to COPD was seen between genders over the study period. Women seemed to have a greater susceptibility to asthma, fractures, osteoporosis, rheumatoid arthritis, rhinitis, depression, and anxiety, but appeared less likely to have diabetes, kidney diseases, and cardiovascular diseases. Furthermore, women had a greater risk of COPD-related hospitalization and were likely to receive a significantly higher number of COPD drug prescriptions compared with men. These results support the need to reduce disease burden among women with COPD and highlight the role of healthcare professionals in primary care who should consider all these parameters in order to properly diagnose and treat women with COPD.
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http://dx.doi.org/10.1038/s41533-019-0157-3DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6904454PMC
December 2019

Establishing a pulmonary rehabilitation programme in primary care in Greece: A FRESH AIR implementation study.

Chron Respir Dis 2019 Jan-Dec;16:1479973119882939

Clinic of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Crete, Greece.

Pulmonary rehabilitation (PR) is an evidence-based, low-cost, non-medical treatment approach for patients with chronic respiratory diseases. This study aimed to start and assess the feasibility, acceptability and impact of a PR programme on health and quality of life of respiratory patients, for the first time in primary care in Crete, Greece and, particularly, in a low-resource rural setting. This was an implementation study with before-after outcome evaluation and qualitative interviews with patients and stakeholders. In a rural primary healthcare centre, patients with chronic obstructive pulmonary disease (COPD) and/or asthma were recruited. The implementation strategy included adaptation of a PR programme previously developed in United Kingdom and Uganda and training of clinical staff in programme delivery. The intervention comprised of 6 weeks of exercise and education sessions, supervised by physiotherapists, nurse and general practitioner. Patient outcomes (Clinical COPD Questionnaire (CCQ), COPD Assessment Test (CAT), St. George's Respiratory Questionnaire (SGRQ), Patient Health Questionnaire-9 (PHQ-9), Incremental Shuttle Walking Test (ISWT)) were analysed descriptively. Qualitative outcomes (feasibility, acceptability) were analysed using thematic content analysis. With minor adaptations to the original programme, 40 patients initiated (24 with COPD and 16 with asthma) and 31 completed PR (19 with COPD and 12 with asthma). Clinically important improvements in all outcomes were documented (mean differences (95% CIs) for CCQ: -0.53 (-0.81, -0.24), CAT: -5.93 (-8.27, -3.60), SGRQ: -23.00 (-29.42, -16.58), PHQ-9: -1.10 (-2.32, 0.12), ISWT: 87.39 (59.37, 115.40)). The direct PR benefits and the necessity of implementing similar initiatives in remote areas were highlighted. This study provided evidence about the multiple impacts of a PR programme, indicating that it could be both feasible and acceptable in low-resource, primary care settings.
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http://dx.doi.org/10.1177/1479973119882939DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6864042PMC
August 2020

Next-generation care pathways for allergic rhinitis and asthma multimorbidity: a model for multimorbid non-communicable diseases-Meeting Report (Part 2).

J Thorac Dis 2019 Sep;11(9):4072-4084

Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany.

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http://dx.doi.org/10.21037/jtd.2019.09.38DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6790426PMC
September 2019

ERS Presidential Summit 2018: multimorbidities and the ageing population.

ERJ Open Res 2019 Jul 25;5(3). Epub 2019 Sep 25.

Coimbra University Hospital, Coimbra, Portugal.

As the average age of the population increases, so will the prevalence of chronic respiratory diseases and associated multimorbidity. This will result in a more complex clinical environment. Part of the solution will be to allow patients to be co-creators in the design of their care. It will also require clinicians to shift in their current approaches to care, step out of the disease- or pathology-oriented approach and embrace new ideas. In an effort to prepare the respiratory community for the challenge, we reflect on concepts to empower patients multidisciplinary systems, new technologies and transition from end-of-life care to advanced care planning.
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http://dx.doi.org/10.1183/23120541.00126-2019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6759575PMC
July 2019

Next-generation care pathways for allergic rhinitis and asthma multimorbidity: a model for multimorbid non-communicable diseases-Meeting Report (Part 1).

J Thorac Dis 2019 Aug;11(8):3633-3642

Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Uniersität zu Berlin and Berlin Institute of Health, Comprehensive Allergy-Centre, Department of Dermatology and Allergy, Member of GA2LEN, Berlin, Germany.

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http://dx.doi.org/10.21037/jtd.2019.08.64DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6753463PMC
August 2019

Next-generation ARIA care pathways for rhinitis and asthma: a model for multimorbid chronic diseases.

Authors:
J Jean Bousquet Holger J Schünemann Alkis Togias Marina Erhola Peter W Hellings Torsten Zuberbier Ioana Agache Ignacio J Ansotegui Josep M Anto Claus Bachert Sven Becker Martin Bedolla-Barajas Michael Bewick Sinthia Bosnic-Anticevich Isabelle Bosse Louis P Boulet Jean Marc Bourrez Guy Brusselle Niels Chavannes Elisio Costa Alvaro A Cruz Wienczyslawa Czarlewski Wytske J Fokkens Joao A Fonseca Mina Gaga Tari Haahtela Maddalena Illario Ludger Klimek Piotr Kuna Violeta Kvedariene L T T Le Desiree Larenas-Linnemann Daniel Laune Olga M Lourenço Enrica Menditto Joaquin Mullol Yashitaka Okamoto Nikos Papadopoulos Nhân Pham-Thi Robert Picard Hilary Pinnock Nicolas Roche Regina E Roller-Wirnsberger Christine Rolland Boleslaw Samolinski Aziz Sheikh Sanna Toppila-Salmi Ioanna Tsiligianni Arunas Valiulis Erkka Valovirta Tuula Vasankari Maria-Teresa Ventura Samantha Walker Sian Williams Cezmi A Akdis Isabella Annesi-Maesano Sylvie Arnavielhe Xavier Basagana Eric Bateman Anna Bedbrook K S Bennoor Samuel Benveniste Karl C Bergmann Slawomir Bialek Nils Billo Carsten Bindslev-Jensen Leif Bjermer Hubert Blain Mateo Bonini Philippe Bonniaud Jacques Bouchard Vitalis Briedis Christofer E Brightling Jan Brozek Roland Buhl Roland Buonaiuto Giorgo W Canonica Victoria Cardona Ana M Carriazo Warner Carr Christine Cartier Thomas Casale Lorenzo Cecchi Alfonso M Cepeda Sarabia Eka Chkhartishvili Derek K Chu Cemal Cingi Elaine Colgan Jaime Correia de Sousa Anne Lise Courbis Adnan Custovic Biljana Cvetkosvki Gennaro D'Amato Jane da Silva Carina Dantas Dejand Dokic Yves Dauvilliers Antoni Dedeu Giulia De Feo Philippe Devillier Stefania Di Capua Marc Dykewickz Ruta Dubakiene Motohiro Ebisawa Yaya El-Gamal Esben Eller Regina Emuzyte John Farrell Antjie Fink-Wagner Alessandro Fiocchi Jean F Fontaine Bilun Gemicioğlu Peter Schmid-Grendelmeir Amiran Gamkrelidze Judith Garcia-Aymerich Maximiliano Gomez Sandra González Diaz Maia Gotua Nick A Guldemond Maria-Antonieta Guzmán Jawad Hajjam John O'B Hourihane Marc Humbert Guido Iaccarino Despo Ierodiakonou Maddalena Illario Juan C Ivancevich Guy Joos Ki-Suck Jung Marek Jutel Igor Kaidashev Omer Kalayci Przemyslaw Kardas Thomas Keil Mussa Khaitov Nikolai Khaltaev Jorg Kleine-Tebbe Marek L Kowalski Vicky Kritikos Inger Kull Lisa Leonardini Philip Lieberman Brian Lipworth Karin C Lodrup Carlsen Claudia C Loureiro Renaud Louis Alpana Mair Gert Marien Bassam Mahboub Joao Malva Patrick Manning Esteban De Manuel Keenoy Gailen D Marshall Mohamed R Masjedi Jorge F Maspero Eve Mathieu-Dupas Poalo M Matricardi Eric Melén Elisabete Melo-Gomes Eli O Meltzer Enrica Menditto Jacques Mercier Neven Miculinic Florin Mihaltan Branislava Milenkovic Giuliana Moda Maria-Dolores Mogica-Martinez Yousser Mohammad Steve Montefort Ricardo Monti Mario Morais-Almeida Ralf Mösges Lars Münter Antonella Muraro Ruth Murray Robert Naclerio Luigi Napoli Leila Namazova-Baranova Hugo Neffen Kristoff Nekam Angelo Neou Enrico Novellino Dieudonné Nyembue Robin O'Hehir Ken Ohta Kimi Okubo Gabrielle Onorato Solange Ouedraogo Isabella Pali-Schöll Susanna Palkonen Peter Panzner Hae-Sim Park Jean-Louis Pépin Ana-Maria Pereira Oliver Pfaar Ema Paulino Jim Phillips Robert Picard Davor Plavec Ted A Popov Fabienne Portejoie David Price Emmanuel P Prokopakis Benoit Pugin Filip Raciborski Rojin Rajabian-Söderlund Sietze Reitsma Xavier Rodo Antonino Romano Nelson Rosario Menahenm Rottem Dermot Ryan Johanna Salimäki Mario M Sanchez-Borges Juan-Carlos Sisul Dirceu Solé David Somekh Talant Sooronbaev Milan Sova Otto Spranger Cristina Stellato Rafael Stelmach Charlotte Suppli Ulrik Michel Thibaudon Teresa To Ana Todo-Bom Peter V Tomazic Antonio A Valero Rudolph Valenta Marylin Valentin-Rostan Rianne van der Kleij Olivier Vandenplas Giorgio Vezzani Frédéric Viart Giovanni Viegi Dana Wallace Martin Wagenmann De Y Wang Susan Waserman Magnus Wickman Dennis M Williams Gary Wong Piotr Wroczynski Panayiotis K Yiallouros Arzu Yorgancioglu Osman M Yusuf Heahter J Zar Stéphane Zeng Mario Zernotti Luo Zhang Nan S Zhong Mihaela Zidarn

Clin Transl Allergy 2019 9;9:44. Epub 2019 Sep 9.

260University Clinic of Respiratory and Allergic Diseases, Golnik, Slovenia.

Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.

Main Body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care.

Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.
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http://dx.doi.org/10.1186/s13601-019-0279-2DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6734297PMC
September 2019