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Vol. 223. Issue 3.
Pages 154-164 (March 2023)
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Vol. 223. Issue 3.
Pages 154-164 (March 2023)
Original article
Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration
Consenso multidisciplinar español sobre las características de los pacientes con asma grave en tratamiento con biológicos susceptibles de pasar a tratamiento domiciliario
C. Cisneros-Serranoa,
Corresponding author

Corresponding author.
, M.J. Rialb, A. Gómez-Bastero-Fernándezc, J.M. Igead, A. Martínez-Mecae, L.C. Fernández-Lisónf, V. López-Carrascog, E. Villamañán-Buenoh, M.J. Plá-Martíi, E. Chinerj
a Pulmonology Department, Hospital Universitario La Princesa, Madrid, Spain
b Allergy Department, Complexo Hospitalario Universitario A Coruña, A Coruña, Spain
c Pulmonology Department, Hospital Universitario Virgen Macarena, Seville, Spain
d Clínica Alergoasma, Salamanca, Spain
e Pulmonology Department Nurse, Hospital Universitario de La Princesa, Madrid, Spain
f Hospital Pharmacy Department, Complejo Hospitalario Universitario de Cáceres, Cáceres, Spain
g Allergy Department Nurse, Hospital Universitario La Paz-Carlos III-Cantoblanco, Madrid, Spain
h Pharmacy Department, Hospital Universitario La Paz, Madrid, Spain
i Allergy Department Nurse, Hospital Universitario La Fe, Valencia, Spain
j Pulmonology Department, Hospital Universitario San Juan d’Alacant, Alicante, Spain
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Figures (2)
Tables (3)
Table 1. Scoring of the extent of agreement of each of the following characteristics when selecting a severe asthma patient who receives biologic therapy as a candidate for at-home administration.
Table 2. Analysis of priority by blocks of the most relevant characteristics when selecting a severe asthma patient who receives biologic therapy as a candidate for at-home administration.
Table 3. Priority weighted by relevance of the most relevant characteristics when selecting a severe asthma patient receiving biologic therapy as a candidate for at-home administration.
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Background and objective

Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified.

Materials and methods

This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital.


One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team’s indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly.


Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.

Severe uncontrolled asthma
Biologic therapy
At-home administration
Monoclonal antibody
Antecedentes y objetivo

Es bien sabido que las terapias biológicas reducen las exacerbaciones y mejoran el tratamiento del asma grave no controlada. La administración domiciliaria de biológicos ha aumentado durante la pandemia de COVID-19, pero aún no se han identificado las características de los pacientes con asma grave no controlada que pueden beneficiarse de la administración domiciliaria de terapia biológica.

Materiales y métodos

Este proyecto se basa en la metodología Delphi, diseñada para alcanzar un consenso entre expertos a través de un comité científico multidisciplinar que aborda las siguientes cuestiones: características clínicas, adherencia al tratamiento, capacidad de administración del paciente o cuidador, autocuidado del paciente, relación con el profesional sanitario, preferencias del paciente y acceso al hospital.


Ciento treinta y un profesionales sanitarios (neumólogos, alergólogos, enfermeros y farmacéuticos hospitalarios) cumplimentaron las dos rondas de consenso del cuestionario Delphi. Se identificaron catorce ítems como características prioritarias, siendo los cinco primeros: 1. El paciente sigue las indicaciones/recomendaciones del equipo sanitario para controlar su enfermedad; 2. El paciente es capaz de detectar cualquier deterioro de su enfermedad y de identificar los factores desencadenantes de las exacerbaciones; 3. El paciente recibe tratamiento biológico y tiene una enfermedad estable sin riesgo vital; 4. El paciente se responsabiliza de su autocuidado, y 5. El paciente tiene obligaciones laborales/educativas que le impiden acudir al hospital con regularidad.


La estabilidad y el control de la enfermedad junto a la capacidad de identificar los factores desencadenantes de las exacerbaciones son las características más importantes a la hora de optar por la administración domiciliaria en un paciente con asma grave no controlada en tratamiento biológico. Estas recomendaciones podrían ser aplicables a la práctica clínica.

Palabras clave:
Asma grave no controlada
Terapia biológica
Administración domiciliaria
Anticuerpo monoclonal


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