|The impact of the Respiratory Advanced Nurse practitioner on the surveillance of severe asthma patients on biologic therapy during COVID-19 pandemic
|FOLLIARD A, LEON G, ROONEY CP, MOKOKA MC.
|Mayo University Hospital
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|To improve adherence to therapy and reduce future exacerbations, a shared decision approach between patients and specialized healthcare providers is essential in management of their disease.
Two severe asthma patients, on optimal asthma medications as per step 5 of GINA guidelines presented with frequent asthma exacerbations despite being on biologic therapy. Close monitoring by RANP included monthly PEFR monitoring, asthma education, assessment of adherence and assessment of airway inflammation using blood eosinophils and serial fractional exhaled nitric oxide (FeNO). Patient contacts were either face to face or virtual in keeping with COVID-19 guidelines. Using a shared decision approach, PEFR data and airway inflammation data: (1) There was an improvement in adherence to inhaler therapy by switching to once daily asthma regimen which led to a reduction in FENO, blood eosinophils and exacerbations; (2) Switching to anti-IL5 therapy was avoided in the second patient. When the patient decided to stop inhaled corticosteroid therapy, detection of early rise in FeNO, blood eosinophils and drop in peak flow led to the patient agreeing to re-commencement of inhaled corticosteroids.
RANP frequent contacts with severe asthma patients and a shared decision making resulted in improved medication adherence, reduction in asthma exacerbations.