title: Personalising care of adults with asthma from Asia: a modified e-Dephi consensus study to inform management tailored to attitude and control profiles.
abstract: REALISE Asia-an online questionnaire-based study of Asian asthma patients-identified five patient clusters defined in terms of their control status and attitude towards their asthma (categorised as: 'Well-adjusted and at least partly controlled'; 'In denial about symptoms'; 'Tolerating with poor control'; 'Adrift and poorly controlled'; 'Worried with multiple symptoms'). We developed consensus recommendations for tailoring management of these attitudinal-control clusters. An expert panel undertook a three-round electronic Delphi (e-Delphi): Round 1: panellists received descriptions of the attitudinal-control clusters and provided free text recommendations for their assessment and management. Round 2: panellists prioritised Round 1 recommendations and met (or joined a teleconference) to consolidate the recommendations. Round 3: panellists voted and prioritised the remaining recommendations. Consensus was defined as Round 3 recommendations endorsed by >50% of panellists. Highest priority recommendations were those receiving the highest score. The multidisciplinary panellists (9 clinicians, 1 pharmacist and 1 health social scientist; 7 from Asia) identified consensus recommendations for all clusters. Recommended pharmacological (e.g., step-up/down; self-management; simplified regimen) and non-pharmacological approaches (e.g., trigger management, education, social support; inhaler technique) varied substantially according to each cluster's attitude to asthma and associated psychosocial drivers of behaviour. The attitudinal-control clusters defined by REALISE Asia resonated with the international panel. Consensus was reached on appropriate tailored management approaches for all clusters. Summarised and incorporated into a structured management pathway, these recommendations could facilitate personalised care. Generalisability of these patient clusters should be assessed in other socio-economic, cultural and literacy groups and nationalities in Asia.
authors.affiliation: Respiratory Effectiveness Group, Cambridge, UK.
authors.forename: Alison
authors.initials: A
authors.lastname: Chisholm
authors.affiliation: Department of Primary Care Respiratory Medicine, University of Aberdeen, Aberdeen, UK.|Observational & Pragmatic Research Institute Pte Ltd, Singapore.
authors.forename: David B
authors.identifier: 0000-0002-9728-9992
authors.initials: DB
authors.lastname: Price
authors.affiliation: Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors.forename: Hilary
authors.initials: H
authors.lastname: Pinnock
authors.affiliation: National University Hospital, Singapore, Singapore.
authors.forename: Tan Tze
authors.initials: TT
authors.lastname: Lee
authors.affiliation: Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
authors.forename: Camilo
authors.initials: C
authors.lastname: Roa
authors.affiliation: Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Sang-Heon
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Section of Pulmonary Medicine, University of the Philippines-Philippine General Hospital, Manila, Philippines.
authors.forename: Aileen
authors.initials: A
authors.lastname: David-Wang
authors.affiliation: Department of Paediatrics, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, China.
authors.forename: Gary
authors.initials: G
authors.lastname: Wong
authors.affiliation: Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
authors.forename: Thys
authors.initials: T
authors.lastname: van der Molen
authors.affiliation: Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, UK.
authors.forename: Dermot
authors.identifier: 0000-0002-4115-7376
authors.initials: D
authors.lastname: Ryan
authors.affiliation: Department of Clinical Epidemiology, College of Medicine; and Institute of Clinical Epidemiology, National Institutes of Health, University of the Philippines, Manila, Philippines.
authors.forename: Nina
authors.initials: N
authors.lastname: Castillo-Carandang
authors.affiliation: Discipline of Social & Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Penang, Malaysia.
authors.forename: Yee Vern
authors.initials: YV
authors.lastname: Yong
mesh_terms: D001208:Asia; D001249:Asthma / Q000628:therapy*; D001294:Attitude to Health; D016000:Cluster Analysis; D032921:Consensus; D003697:Delphi Technique; D019468:Disease Management; D006723:Hong Kong; D006801:Humans; D008296:Malaysia; D009426:Netherlands; D010353:Patient Education as Topic; D010679:Philippines; D017410:Practice Guidelines as Topic; D056910:Republic of Korea; D012846:Singapore; D006113:United Kingdom