How to Build a Severe Asthma Clinic in Low- and Middle-Income Countries?

Purpose of ReviewSevere asthma causes a high burden of morbidity and costs for healthcare systems, especially in low- and middle-income countries, where patients continue to be treated exclusively in primary care settings and face many barriers to accessing high-quality healthcare. Evidence has shown that managing patients with severe asthma in specialized clinics with an interdisciplinary team and continuous and systematic evaluation improves cost-effectively disease outcomes. In this article, we will delve into the main challenges faced and the valuable lessons learned throughout the building and implementation of a severe asthma clinic, in a tertiary respiratory care institution located in Colombia, a middle-income country, and using this documented experience we pose how to build severe asthma clinics/programs applicable to low- and middle-income countries.Recent FindingsIt has been documented that patients with severe asthma in low- and middle-income countries experience multiple barriers in having a proper diagnosis, timely periodic medical and test follow-up appointments, proper educational support, and opportune delivery of medications, perpetuating asthma exacerbations and poor control. Multidisciplinary clinics have been shown to be useful in improving clinical outcomes and reducing costs of severe asthma care in high-income developed countries, but there is very little information on the feasibility of implementing these types of clinics in low- and middle-income countries. Three years ago, with the cumulative experience of our general asthma program, we decided to organize and implement the institutional severe asthma clinic (Asmaire ReXpira) the which, with just this short time of operation, has successfully demonstrated improvement in quality of life, exacerbation rates, and disease control of the patients, with education being the most important tool for achieving these results.SummaryWe have confirmed the feasibility of establishing and the importance of developing an interdisciplinary SAC in a middle-income country, and using this experience we pose that it is also necessary and feasible to build non-complex, lower sophisticated successful SACs in LMICs, despite the challenges that may arise during this process. These SACs, adopting a systematic and multidimensional evaluation of the patients, have shown to decrease rates of clinically relevant asthma exacerbations and systemic steroid use while improving symptom control, lung function, and overall quality of life. We suggest that education stands as the cornerstone of successful SACs, enabling the patients with essential skills for self-managing their disease effectively in both the short and long term.