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Transition of adolescents with severe asthma from pediatric to adult care in Spain: the STAR consensus

Valverde-Molina J1, Fernández-Nieto M2, Torres-Borrego J3, Lozano Blasco J4, de Mir-Messa I5, Blanco-Aparicio M6, Nieto A7, Figuerola Mulet J8, Moure AL9, Sánchez-Herrero MG9, Sánchez-García S10

1Servicio de Pediatría, H.G. Universitario Santa Lucía, Cartagena.
2Allergy Department UMA, Fundación Jiménez Díaz, CIBERES.
3Unidad Alergologia y Neumología Pediátricas, H. Universitario Reina Sofía, Córdoba.
4Servicio Alergología e Inmunología Clínica, Hospital Sant Joan de Deu, Barcelona.
5Pediatric Pulmonology, Alergology and Cystic Fibrosis Unit, Hospital Universitari Vall d'Hebron, Barcelona, España. Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron Barcelona, España.
6Servicio de Neumología. Hospital Universitario A Coruña. Coordinadora del Area de Asma de SEPAR.
7Pediatra – Alergólogo, Instituto de Investigación Sanitaria La Fe, Valencia.
8Sección de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Baleares. Instituto de Investigación Sanitaria de les Illes Balears (IdiSBa).
9Medical Department, GSK, Tres Cantos, Madrid, Spain.
10Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain.

J Investig Allergol Clin Immunol 2023; Vol. 33(3)
doi: 10.18176/jiaci.0780

Objective: To assess the consensus level among a multidisciplinary expert panel on the transition of adolescents with severe asthma from pediatric to adult care.
Methods: A 61-item survey was developed based on guidelines for other chronic pathologies, covering transition planning, preparation, effective transfer, and follow-up. A two-round Delphi process assessed the consensus level among 98 experts (49 pediatricians, 24 allergists and 25 pulmonologists). Consensus was established with ≥70% agreement.
Results: Forty-two items (70%) reached consensus. No age range to initiate the transition was agreed upon by the panelists. The main goal to achieve during the transition identified by the experts is that adolescents gain autonomy to manage their severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient’s autonomy, and identifying home environment factors. They agreed that the adult healthcare team should have expertise in severe asthma, biologics and management of adolescent patients. Pediatric and adult healthcare teams should share clinical information, agree on the criteria to maintain the biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult healthcare professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, treatment adherence and attendance to healthcare appointments.
Conclusions: This consensus document provides the first roadmap for Spanish pediatric and adult teams to ensure that key aspects of the transition process in severe asthma are covered. The implementation of these recommendations will improve the quality of care offered to the patient.

Key words: Adolescent, Consensus, Delphi process, Pediatric patient, Severe asthma, Transition process, Recommendations, Biologics