D1.112 - Managing patients with Type 2 inflammation in a joint interdisciplinary “United Airways Clinic” at Lund University Hospital, Sweden

Severe and difficult-to-treat asthma often presents with comorbidities also associated with the underlying T2-high pathology, such as chronic rhinosinusitis with or without nasal polyps (CRSw/sNP).

In order to improve the patient journey in the healthcare system and to come to timely decisions about optimal treatment, interdisciplinary cooperation and collaboration is being discussed in different healthcare settings.

Such a cooperative clinic model was jointly implemented by the respective outpatient units of the Departments of Asthma & Allergology (Lung Clinic) and Allergy (ENT Clinic) at Lund University Hospital in Southern Sweden.

Documentation and description of the collaboration process and outcomes, including personal experience and observations of doctors involved.

Joint clinics were organized from December 2022 onwards approximately every three months. Patients were selected from the population under the care of the treating allergologist/asthma physician (AAP), often while still in the process of investigating the presenting phenotype. Patients were booked for follow-up appointments with spirometry and FeNO measurements and then seen jointly by the AAP and the ENT physician, the latter performing rhinoscopy under local anesthesia for visualization of relevant pathologies. The patients were then jointly discussed, and management plans were formed.

 Over the course of this pilot project, patients were jointly evaluated on eight occasions.  Due to logistic and organizational reasons it was felt that the optimal number of patients to be seen per clinic should not be more than three.

Overall 14 patients with severe asthma and suspected or known nasal pathology were evaluated (male n=8, female n=6; age range 22-63, mean age 48 yrs). 9 patients had known CRSwNP. In 2 patients the suspected but unconfirmed presence of nasal polyps could be demonstrated. Other sinonasal pathologies encountered were allergic or other unspecified rhinitis and septal deviations.

In 3 patients it was jointly decided to institute biologic treatment with a monoclonal antibody targeting the IL4 and IL13 pathways (dupilumab) with proven efficacy both in eosinophilic asthma and CRSwNP. In other patients the outcome of the joint evaluation was to intensify asthma therapy with inhaled medicines, or to directly plan operations such as functional endoscopic sinus surgery (FESS), or to wait and see with close follow-up.

Overall the joint interdisciplinary approach resulted in a faster decision time to institute targeted therapy based on a full picture of the relevant pathology.

Joint “United Airways Clinics” were seen as a useful tool for interdisciplinary cooperation to deliver coordinated care to a very select patient population. Based on patient feedback, the clinics with two doctors in the same room were experienced as positive, confirming our aim to deliver care “for the whole person” instead of a strictly organ-based approach. It is planned to firmly institute these clinics several times a year. Time and organizational energy are well spent on this novel model of healthcare delivery.