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Expert-guided Online Decision Tool Supports Real-time Treatment Choice for Severe Asthma


Treatment for severe asthma may be enhanced using an online decision support tool that draws on expert treatment decisions for a wide variety of potential patient scenarios.

An expert-guided online decision support tool that can provide individualized recommendations for treating severe asthma in real time is highlighted at the 2021 American Academy of Allergy, Asthma and Immunology (AAAAI) Virtual Annual Meeting, February 26 – March 1, 2021.

Five asthma experts were invited to develop treatment choices for patient scenarios that clinicians would customize using the tool. The authors goal was to provide real-time recommendations for severe asthma based on patient-specific characteristics and to identify variances between the treatment strategies of experts and community clinicians.

The asthma experts provided treatment recommendations for a combination of patient variables totaling 70 possible scenarios based on:

  • FeNO
  • Blood eosinophils
  • Allergic phenotype
  • IgE
  • Other allergies/comorbidities
  • Body weight
  • Childbearing potential

The resulting decision support tool allows a clinician to create a specific patient scenario using these variables and then select a treatment plan. In response to that choice, experts’ treatment recommendations are shown and, if discordant, clinicians are asked if the expert recommendation led them to change their initial plan.

Among the 5 experts, there was concordance in treatment selection across specific asthma patient scenarios. For example:

  • For chronic urticaria, most added an anti-IgE biologic
  • For allergic asthma with FeNO < 20 ppb; eosinophils < 150 mL; no atopic dermatitis, chronic rhinosinusitis, or nasal polyps, most added an anti-IgE biologic
  • For atopic dermatitis, chronic rhinosinusitis, or nasal polyps, most added an anti–IL-4 receptor biologic

To date, more than 90 patient scenarios have been entered in the tool by 54 unique clinicians. Next steps include detailed analysis of variance between treatment planned by the experts vs community clinicians.

The abstract (#122) will be presented at the 2021 AAAAI Virtual Annual Meeting.

The full meeting program is available on the AAAAI website.

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