Innovation on Global Pathway Care for Allergic Rhinitis and Its Impact to Asthma

1. Innovation on Global
Pathway Care
for Allergic Rhinitis and Its
Impact to Asthma (ARIA)
MADE ARY SARASMITA
D301108011

2. Outline
Background
ARIA
Initiative
Discussion Conclusion

3. Background
• Asthma and allergic rhinitis occurs frequently
• Rhinitis occurs in 75% of patients with allergic asthma
• The same triggers (allergens) can cause rhinitis and asthma
• Actively untreated rhinitis is a risk factor for asthma exacerbations
• Upper and lower airways share a common and probably
interconnected inflammatory disease
• Common inflammatory cells : mast cells, eosinophils, T-Cells(2)
• Common inflammatory mediators : histamine, leukotrienes, cytokines(3)
• Bronchial challenge leads to nasal inflammation, and nasal challenge leads
to bronchial inflammation(3)
1. Bousquet J and the ARIA Workshop Group, J Allergy Clin Immunol 2001; 108(5):S147-S334
2. Management of Allergic Rhinitis and Its Impact on Asthma (ARIA) Pocket Guide. A Pocket Guide for Physicians and Nurses, 2001.

6. History of Programme Implementation
• Allergic Rhinitis and Its Impact on Asthma (ARIA)  initiated
during WHO workshop in 1999  published in 2001
• Reflects patients’ need and underlines the close relationship
between rhinitis and asthma
• 2010  Clinical Practice Guideline for the management of AR and
asthma comorbidities based on Grading of Recommendation,
Assessment, Development and Evaluation (GRADE) system 
implemented in > 50 countries of the world.
J. Bousquet, MD et al, Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and future needs, J
ALLERGY CLIN IMMUNOL VOLUME 130, NUMBER 5

7. ARIA Innovative
• Proposing a new AR classification using persistence
and severity of symptoms
• Promoting the concept of comorbidities in asthma
and rhinitis as a key factor for patients management
• Developing guideline in collaboration with all
stakeholders including primary care physician,
experts and patients.
• Adopting an evidence based approach and initiating
global implementation among health care
professionals and patients.
J. Bousquet, MD et al, Allergic Rhinitis and its Impact on Asthma (ARIA): Achievements in 10 years and
future needs, J ALLERGY CLIN IMMUNOL 2010, VOLUME 130, NUMBER 5

10. Care pathways implementing
emerging technologies for predictive
medicine in rhinitis and asthma across
the life cycle
• It is now focusing on the implementation of emerging
technologies for individualized and predictive medicine.
• New developments which have facilitated this process
include the introduction of the visual analogue scale (VAS)
as the common validated language of AR control
• Incorporation of this VAS into simple interactive apps for
both patients (ARIA Allergy Diary) and HCPs (ARIA Allergy
Diary Companion)
• MASK-rhinitis and asthma is a simple ICT tool used to
implement ICPs for AR and asthma by means of a common
language (for patients and HCPs) and a CDSS.
Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle
Clin Transl Allergy (2016) 6:47

11. Differences of Guideline, Clinical Practice Guideline and Care Pathway
GUIDELINE CLINICAL PRACTICE GUIDELINE CARE PATHWAY
Focus Specific clinical circumstance Treatment and/or prevention The quality and coordination of
care
Definition Systematically developed statements to help
practitioners and patients make decisions
about appropriate health care
A suggested course of treatment and/or
treatment service for a specific diagnosis,
functional deficit or problem area
Structured, multidisciplinary plans
of care
Goals Makes specific recommendations on
heathcare and link these to research evidence
Highlight major therapeutic or preventive
interventions identifies choices of different
course of path of treatment
Supports the implementation of
clinical guidelines and protocols
Output Provides a summary and appraisal of the best
available research evidence or expert
consensus; highlights the strength of the
evidence underlying each recommendation
Provide a logical flow of interventions.
Provide detailed recommendations
Provide detailed guidance for each
stage in the management of
patient and key performance
indicators
Uses Clinicians, patients and third parties (all
stakeholders involved)
Specific to clinicians A multidisciplinary clinical team
Component 1) Appraisal of literature (research evidence
or expert consensus)
2) Summary of recommendations
3) An outline of how guideline should be
implemented and how adherence
monitored
List of major therapeutic or preventive
interventions, goal : when interventions
should be achieved, options for different
choice of treatment and/or prevention
1) Timeline
2) Categories of case /
intervention
3) Intermediate and long term
outcome criteria
4) A valance record
http://www.implementationcentral.com/guideline_8.html

12. Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle Clin Transl Allergy (2016) 6:47

13. MASK : ARIA Allergy Diary and ARIA Allergy
Diary Companion Apps
• A pilot study  available in 15 EU countries, Australia, Mexico, Switzerland and in
15 language)  importance of the tools to stratify patients, assess their work
productivity and improve quality of life
• Questionnaires  on work, on school, daily activitie, on sleep  5000 users 
applied every week to assess disease impact on patient QoL and productivity at
work
• Treatments received
• Daily visual analogue scale  global symptoms due to allergic dis, rhinitis,
conjunctivitis, asthma, and work productivity
• Clinical Decision Support System 
• an algorithm to aid clinicians to select pharmacotherapy for patients with AR and stratify their
disease severity  step up/step down individualized approach
• Depending on the availability of medication in the different countries and on resources.
Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle Clin Transl Allergy (2016) 6:47

14. Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle Clin Transl Allergy (2016) 6:47

15. Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle Clin Transl Allergy (2016) 6:47

16. Bousquet et al. ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle Clin Transl Allergy (2016) 6:47

17. Hellings et al. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)Clin Transl Allergy (2017) 7:49

18. Hellings et al. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)Clin Transl Allergy (2017) 7:49

19. Hellings et al. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)Clin Transl Allergy (2017) 7:49

20. Hellings et al. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)Clin Transl Allergy (2017) 7:49

21. Hellings et al. European Summit on the Prevention and Self-Management of Chronic Respiratory Diseases: report of the European Union Parliament Summit (29 March 2017)Clin Transl Allergy (2017) 7:49

23. Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

24. Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

25. Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

26. Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

27. Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

28. Main Lesson Learned
Adherence to treatment is the major problem of allergic disease
Self management strategies should be considerably expanded (behavioural)
Change management is essential in allergic disease
Education strategies should be reconsidered using a patient centered approach
Lessons can be expnded to other chronic disease
Bousquet et al. Guidance to 2018 good practice: ARIA digitally-enabled, integrated, person-centred care for rhinitis and asthma, Clin Transl Allergy (2019) 9:16

29. Improvement and Expansion of the Practice
Patient participation, health
literacy and self care
through technology-
assisted “patient
activation”
Implementation of care
pathways by pharmacists
Next generation guidelines
assessing the
recommendations in rhinitis
and asthma using real
world evidence assessed by
mobile technology