Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee - 05/04/23

Doi : 10.1016/j.jaci.2023.01.017

Anil Nanda, MD ^a,^b, Roxana Siles, MD ^c, Henna Park, DO ^d, Margee Louisias, MD, MPH ^e,^f,^g, Barbara Ariue, MD ^h, Maria Castillo, MD ⁱ, Mahesh Padukudru Anand, DNB ^j, Anh P. Nguyen, MD, MPH ^k, Tiffany Jean, MD ^l, Michael Lopez, MD ^l, Roula Altisheh, MD ^c, Andrea A. Pappalardo, MD ^m,^⁎
^a Asthma and Allergy Center, Lewisville–Flower Mound
^b Division of Allergy and Immunology, University of Texas Southwestern Medical Center, Dallas
^c Department of Allergy and Clinical Immunology, Respiratory Institute, Cleveland Clinic Foundation, Cleveland
^d Department of Pediatrics, University of Illinois Hospital, Chicago
^m Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, Chicago
^e Department of Medicine, Division of Allergy and Clinical Immunology, Brigham and Women’s Hospital, Cleveland
^f Department of Immunology, Boston Children’s Hospital, Boston
^g Harvard Medical School, Boston
^h Department of Pediatrics, Division of Allergy/Immunology, Loma Linda Children’s Hospital, Loma Linda
ⁱ Department of Medical Education at Driscoll Children’s Hospital, Corpus Christi
^j Department of Respiratory Medicine, JSS Medical College, JSS Academy of Higher Education and Research, Mysore
^k Division of Allergy, Immunology, and Rheumatology, Department of Pediatrics, School of Medicine, University of California Davis, Sacramento
^l Division of Basic and Clinical Immunology, Department of Medicine, University of California Irvine, Orange

^∗Corresponding author: Andrea A. Pappalardo, MD, Department of Pediatrics, Department of Medicine, University of Illinois at Chicago, 840 S. Wood Street, MC 856, Chicago, IL 60612.Department of Pediatrics, Department of Medicine, University of Illinois at Chicago840 S. Wood Street, MC 856ChicagoIL60612

Abstract

The most recent recommendations from the 2020 National Asthma Education and Prevention Program Update and Global Initiative for Asthma 2021 guide evidence-based clinical decision making. However, given the present state of health disparities by age, income, and race, the equitable implementation and dissemination of these guidelines will be unlikely without further guidance. This work group report reviews the current state of the new asthma guideline implementation; presents updated evidence-based therapeutic options with attention to specific patient populations; and addresses barriers to the implementation of these guidelines in minoritized, historically marginalized, and underresourced communities. Allergists and immunologists can use practical ways to accomplish the goals of improved asthma care access and advanced asthma care across the life span, with specific considerations to historically marginalized populations. Modifiable barriers to guideline implementation include financial barriers, environmental factors, and allergy subspecialty access and care coordination. Various programs to improve access to guideline-based asthma care include community programs, school-based asthma programs, and digital health solutions, with an emphasis on reducing disparities by race.

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Key words : Asthma, access, underserved, equity, NAEPP, guidelines, barriers, technology, community

Abbreviations used : AAP, CHW, COVID-19, ED, EtD, FDA, GINA, ICS, NAEPP, NHLBI, SABA, SEM, SMART

Plan

Disclosure of potential conflict of interest: R. Siles serves on advisory boards for AstraZeneca and Regeneron. M. Louisias received support from NIH/NHLBI L30 HL143781, Brigham and Women's Hospital Minority Faculty Career Development Award, Robert A. Winn Diversity in Clinical Trials Career Development Award funded by Bristol Myers Squibb Foundation; is a consultant for RubiconMD; and has served on an advisory board for Sanofi. A. A. Pappalardo receives grant funding through the American Lung Association, the NIH, AHRQ, and FARE; has served on the Medical Advisory Board for Takeda, Sanofi/Regeneron in the past year; is a consultant for OptumRx/United Health Group; and is on the board of the Chicago Asthma Consortium. The rest of the authors declare that they have no relevant conflicts of interest.

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Vol 151 - N° 4

P. 869-880 - avril 2023 Retour au numéro

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Ensuring equitable access to guideline-based asthma care across the lifespan: Tips and future directions to the successful implementation of the new NAEPP 2020 guidelines, a Work Group Report of the AAAAI Asthma, Cough, Diagnosis, and Treatment Committee - 05/04/23

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