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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 M2,3, Torres-Borrego J4, Lozano Blasco J5, de Mir-Messa I6,7, Blanco-Aparicio M8,9, Nieto A10, Figuerola Mulet J11,12, Moure AL13, Sánchez-Herrero MG13, Sánchez-García S14

1Servicio de Pediatría, H.G. Universitario Santa Lucía, Cartagena, Spain
2Allergy Department UMA, Fundación Jiménez Díaz, Madrid, Spain
3CIBERES, Spain
4Unidad Alergología y Neumología Pediátricas, Hospital Universitario Reina Sofía, Córdoba, Spain
5Servicio Alergología e Inmunología Clínica, Hospital Sant Joan de Déu, Barcelona, Spain
6Pediatric Pulmonology, Allergology and Cystic Fibrosis Unit, Hospital Universitari Vall d'Hebron, Barcelona, Spain
7Vall d'Hebron Research Institute (VHIR), Hospital Universitari Vall d'Hebron, Barcelona, Spain
8Servicio de Neumología, Hospital Universitario A Coruña, A Coruña, Spain
9Coordinadora del Área de Asma de SEPAR
10Instituto de Investigación Sanitaria La Fe, Valencia, Spain
11Sección de Neumología y Alergia Pediátrica, Servicio de Pediatría, Hospital Universitario Son Espases, Palma de Mallorca, Spain
12Instituto de Investigación Sanitaria de les Illes Balears (IdiSBa)
13Medical Department, GSK, Tres Cantos, Madrid, Spain
14Allergy Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain

J Investig Allergol Clin Immunol 2023; Vol 33(3) : 179-189
doi: 10.18176/jiaci.0780

Objective: To assess the degree of consensus 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 diseases, covering transition planning, preparation, effective transfer, and follow-up. A 2-round Delphi process assessed the degree of consensus among 98 experts (49 pediatricians, 24 allergists, and 25 pulmonologists). Consensus was established with ≥70% agreement.
Results: Consensus was reached for 42 items (70%). Panelists were unable to agree on an age range for initiation of transition. The main goal during the transition identified by the experts is for adolescents to gain autonomy in managing severe asthma and prescribed treatments. The panelists agreed on the importance of developing an individualized plan, promoting patient autonomy, and identifying factors associated with the home environment. They agreed that the adult health care team should have expertise in severe asthma, biologics, and management of adolescent patients. Pediatric and adult health care teams should share clinical information, agree on the criteria for maintaining biological therapy, and have an on-site joint visit with the patient before the effective transfer. Adult health care professionals should closely follow the patient after the effective transfer to ensure correct inhaler technique, adherence, and attendance at health care 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