Working to identify and engage patients with severe asthma, the Duke Asthma, Allergy and Airway Center is proactively building a patient-focused strategy designed to reduce the cost of care while offering patients more effective, state-of-the-art treatment options.

Patients with moderate to severe asthma require more frequent and intensive medical care, says Amber J. Oberle, MD, a Duke pulmonologist who specializes in asthma. Approximately 5 to 10% of patients account for all asthma treatment in the U.S., typically requiring emergency visits, hospital stays, and intensive therapy in critical care settings.

“While patients with severe asthma make up relatively few patients within this population, their care consumes the bulk of these resources,” Oberle says. “In a health care market that is changing to a value-based system, we want to have a strategy that cannot only identify these patients locally and regionally but offer our services in a targeted fashion to provide effective care and management of their condition.”

The clinic also works to standardize treatment and longitudinal management of patients, Oberle says. “We are also creating an asthma research database and a collaborative study of this patient population to better refine our therapies,” she adds.

The emphasis on a value-based care approach to patients with severe asthma is just one dimension of the multispecialty allergy and immunology clinic. The approach incorporates biological therapies, biomarker analysis, and emerging research to design novel treatments for a wide demographic that ranges from patients too old for pediatric care but too young for chronic therapies prescribed for adults.

The effectiveness and growing acceptance of biological therapies offer the physicians more options to customize treatments, says Haley Hostetler, MD, an allergy and immunology specialist.

“Biologic formulations allow us to tailor the regimen for each patient based on their underlying disease process and the factors that contribute to their allergies,” says Haley Hostetler, MD. “These drugs are making a significant difference for this patient group.” Five biological agents are available to treat Type 2 inflammation in asthma; dupilumab and omalizumab are among the most commonly prescribed biologicals.

The process of matching the biological drug to the patient’s condition continues to evolve based on emerging research, Oberle and Hostetler say. “More patients will benefit as the biological options continue to expand,” Oberle says. The clinic monitors ongoing trials and encourages patient participation when appropriate.

“Our multispecialty approach includes asthma specialists as well as pulmonologists and immunologists,” Oberle says. “Patients benefit from our concentration of specialists. We are better able to guide patients toward clinical trials for which they are best suited.”

Oberle says the team works to reduce oral corticosteroid use because of deleterious effects associated with prolonged use. “The new treatments, including biologicals, help us significantly improve the quality of life for many patients,” she says. “That’s the hallmark of our work: providing excellent, novel care while encouraging research.”