The impossibility of face-to-face follow-up visits during the COVID-19 pandemic and the need to provide patients with ongoing medical care led to an increase in remote follow-up consultations for the management of patients with chronic diseases such as severe asthma1–5. As a consequence, today there is a new reality in severe asthma management, with a prominence of remote visits as a good alternative for ensuring that follow-up is compatible with work-life balance while ensuring the quality and continuity of healthcare.

The future of telemedicine in respiratory conditions in Europe has started to become a reality. Various scientific societies are already advocating for its use6,7, supporting the development of strategies and initiatives for implementing remote consultations for patients with severe asthma3,8. However, to ensure that severe asthma patients receive the quality care they need, tools to improve remote follow-up consultations must be developed. These tools must focus on training patients on their specific educational needs while also enabling healthcare professionals to analyze the disease’s progress in this new scenario.

In this context, a detailed analysis of the different perspectives on COVID-19’s impact on patients with severe asthma and the healthcare provided to these patients during the pandemic was performed. This analysis detected a specific need regarding how to ease the transition to a hybrid model that combines face-to-face and remote follow-up visits. It also highlighted the need to set up training programs to ensure quality care for patients, who need to be prepared in advance before receiving medical care in this new manner.

To this end, a multidisciplinary group of nine specialists with expertise in severe asthma (allergists, pulmonologists, and specialist nurses from severe asthma units) developed a tool geared towards improving remote follow-up consultations with a particular emphasis on patient needs. This tool has been validated in patients to ensure its comprehensibility and evaluate their willingness to use this tool. For this purpose, eight cognitive interviews with patients from different geographical backgrounds were conducted. All patients were diagnosed with severe asthma (more than two years since diagnosis) and had previous experience with remote consultations. The results were very favorable; the subjects expressed their wish that this type of material could soon be implemented in clinical practice.

The final version of the tool, called onasm@, is available in its English version at the Supplementary material. It is structured in three blocks (Fig. 1):

• 1

  General considerations on how to conduct a remote follow-up visit, underlining the importance of remote consultation, as well as the need for the patient to prepare for the remote visit in advance and commit to keeping the appointment to maximize the effectiveness of this type of consultation.

• 2

  Data log for patients to record the information that the healthcare professional will elicit from them during the remote visit (e.g., treatment regimen, degree of compliance, visits to the emergency room, at-home asthma attacks resolved with rescue medication, and the need for oral corticosteroids or antibiotics) to make the visit more productive, simple, and effective.

• 3

  Advice to improve asthma control, mainly focused on the importance of following the advice given by the medical team and leading a healthy lifestyle.

Figure 1.

Sections and content included in the proposed tool to support severe asthma patients while preparing for their remote follow-up visits with the specialists.

ACT™: Asthma Control Test; cACT™: Childhood Asthma Control Test.

(0.68MB).

Moreover, in line with the European Respiratory Society Guidelines and the Global Strategy for Asthma Management and Prevention (GINA) recommendations for correct asthma monitoring and management, the tool includes the Asthma Control Test (ACT™) for adults and the version for children (cACT™) to be completed by the parents of pediatric patients.

This eminently practical tool empowers severe asthma patients by enabling them to understand the relevance of remote follow-up visits, learn about their dynamics, and prepare for them in advance by compiling all the information they should know and will be asked for during the remote consultation in a single document; this will also help them in face-to-face visits. In addition, remote follow-up visits allow for reducing hospital visits and empower the patient by giving them greater time flexibility and favoring work-life balance.

One indicator of maturity in the remote patient care field is the amount of information available, its format and structure, and how flexibly it can be adapted to each patient’s needs9,10. Information can be leveraged to help guarantee the patient’s constancy and engagement11, which is highly important in chronic diseases. Targeting remote care in a vulnerable population requires creating a climate of trust in the efficacy, safety, and confidentiality of the telemedicine system in which patients feels comfortable and well-informed11.

In asthma, remote follow-up visits may offer benefits in terms of improving disease control, health-related quality of life (HR-QoL), exacerbations, hospital admissions, exercise capacity, and health resource use (including visits to the emergency room)12. To date, the great heterogeneity in methodology, variables, and patient populations analyzed in telemedicine studies has rendered it difficult to draw clear conclusions about their efficacy and feasibility in asthma, particularly in long-term follow-up4,13,14. Also, although telemedicine can be cost-effective, cost-efficient, and successful14, there are barriers to its widespread use, such as the lack of a clear legislative environment, a scarcity of information, organizational and technical constraints, and resistance from potential users3,9,15. Stakeholder acceptance, integration into the electronic health record, and cost-effectiveness are keys to success12. Work is now under way to identify factors that will accelerate the implementation of telemedicine in respiratory medicine3,8 and contingency plans are being developed to include it as a standard of care for asthma patients1.

In this context, this initiative and the onasm@ tool seek to ease the transition to a hybrid care model, making patients aware of the importance of non-face-to-face visits. This will enable them to adopt the right habits for preparing for remote follow-up visits, promoting fluent communication with the healthcare professional and more efficient appointments while also ultimately working to the benefit of the healthcare system (improved quality of life and patient satisfaction, greater flexibility, and optimization of time and resources, to name but a few factors)4,13,14. Informed and humanized remote healthcare can facilitate the process of transforming care practice and consequently the care provided to severe asthma patients.