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Review
. 2019 Sep 9;9:44.
doi: 10.1186/s13601-019-0279-2. eCollection 2019.

Next-generation ARIA Care Pathways for Rhinitis and Asthma: A Model for Multimorbid Chronic Diseases

J Jean Bousquet  1   2   3   4 Holger J Schünemann  5 Alkis Togias  6 Marina Erhola  7 Peter W Hellings  3   8   9 Torsten Zuberbier  4   10 Ioana Agache  11 Ignacio J Ansotegui  12 Josep M Anto  13   14   15   16 Claus Bachert  17 Sven Becker  18 Martin Bedolla-Barajas  19 Michael Bewick  20 Sinthia Bosnic-Anticevich  21   22   23 Isabelle Bosse  24 Louis P Boulet  25 Jean Marc Bourrez  26 Guy Brusselle  27 Niels Chavannes  28 Elisio Costa  29 Alvaro A Cruz  30   31 Wienczyslawa Czarlewski  32 Wytske J Fokkens  3   33 Joao A Fonseca  34   35 Mina Gaga  36 Tari Haahtela  37 Maddalena Illario  38 Ludger Klimek  39 Piotr Kuna  40 Violeta Kvedariene  41 L T T Le  42 Desiree Larenas-Linnemann  43 Daniel Laune  44 Olga M Lourenço  45 Enrica Menditto  46 Joaquin Mullol  47   48 Yashitaka Okamoto  49 Nikos Papadopoulos  50   51 Nhân Pham-Thi  52 Robert Picard  53 Hilary Pinnock  54 Nicolas Roche  55 Regina E Roller-Wirnsberger  56 Christine Rolland  57 Boleslaw Samolinski  58 Aziz Sheikh  54 Sanna Toppila-Salmi  37 Ioanna Tsiligianni  59   60 Arunas Valiulis  61 Erkka Valovirta  62 Tuula Vasankari  63 Maria-Teresa Ventura  64 Samantha Walker  65 Sian Williams  62 Cezmi A Akdis  66 Isabella Annesi-Maesano  67 Sylvie Arnavielhe  44 Xavier Basagana  13   14   15   16 Eric Bateman  68 Anna Bedbrook  1 K S Bennoor  69 Samuel Benveniste  70 Karl C Bergmann  4   10 Slawomir Bialek  71 Nils Billo  72 Carsten Bindslev-Jensen  73   74 Leif Bjermer  75 Hubert Blain  76   77 Mateo Bonini  78   79 Philippe Bonniaud  80 Jacques Bouchard  81   82 Vitalis Briedis  83 Christofer E Brightling  84   85 Jan Brozek  5 Roland Buhl  86 Roland Buonaiuto  87 Giorgo W Canonica  88 Victoria Cardona  89 Ana M Carriazo  90 Warner Carr  91 Christine Cartier  92 Thomas Casale  93 Lorenzo Cecchi  94 Alfonso M Cepeda Sarabia  95   96 Eka Chkhartishvili  97 Derek K Chu  3 Cemal Cingi  98 Elaine Colgan  99 Jaime Correia de Sousa  100   101 Anne Lise Courbis  102 Adnan Custovic  103 Biljana Cvetkosvki  21   22   23 Gennaro D'Amato  104 Jane da Silva  105 Carina Dantas  106   107 Dejand Dokic  108 Yves Dauvilliers  109 Antoni Dedeu  110   111 Giulia De Feo  112 Philippe Devillier  113 Stefania Di Capua  114 Marc Dykewickz  115 Ruta Dubakiene  116 Motohiro Ebisawa  117 Yaya El-Gamal  118 Esben Eller  73   74 Regina Emuzyte  119 John Farrell  101 Antjie Fink-Wagner  120 Alessandro Fiocchi  121 Jean F Fontaine  122 Bilun Gemicioğlu  123 Peter Schmid-Grendelmeir  124 Amiran Gamkrelidze  125 Judith Garcia-Aymerich  13 Maximiliano Gomez  126 Sandra González Diaz  127 Maia Gotua  128 Nick A Guldemond  129 Maria-Antonieta Guzmán  130 Jawad Hajjam  131 John O'B Hourihane  132 Marc Humbert  133 Guido Iaccarino  134 Despo Ierodiakonou  59   62 Maddalena Illario  35 Juan C Ivancevich  135 Guy Joos  25 Ki-Suck Jung  136 Marek Jutel  137 Igor Kaidashev  138 Omer Kalayci  139 Przemyslaw Kardas  140 Thomas Keil  141   142 Mussa Khaitov  143 Nikolai Khaltaev  144 Jorg Kleine-Tebbe  145 Marek L Kowalski  146 Vicky Kritikos  21   22   23 Inger Kull  147   148 Lisa Leonardini  149 Philip Lieberman  150 Brian Lipworth  151 Karin C Lodrup Carlsen  152   153 Claudia C Loureiro  154 Renaud Louis  155 Alpana Mair  156 Gert Marien  3 Bassam Mahboub  157 Joao Malva  107   158 Patrick Manning  159 Esteban De Manuel Keenoy  160 Gailen D Marshall  161 Mohamed R Masjedi  162 Jorge F Maspero  163 Eve Mathieu-Dupas  44 Poalo M Matricardi  164 Eric Melén  148   165 Elisabete Melo-Gomes  166 Eli O Meltzer  167 Enrica Menditto  46 Jacques Mercier  168 Neven Miculinic  169 Florin Mihaltan  170 Branislava Milenkovic  171 Giuliana Moda  172 Maria-Dolores Mogica-Martinez  173 Yousser Mohammad  174   175 Steve Montefort  176 Ricardo Monti  177 Mario Morais-Almeida  178 Ralf Mösges  179   180 Lars Münter  181 Antonella Muraro  182 Ruth Murray  183   184 Robert Naclerio  185 Luigi Napoli  186 Leila Namazova-Baranova  187 Hugo Neffen  188   189 Kristoff Nekam  190 Angelo Neou  191 Enrico Novellino  192 Dieudonné Nyembue  193 Robin O'Hehir  194 Ken Ohta  195 Kimi Okubo  196 Gabrielle Onorato  1 Solange Ouedraogo  197 Isabella Pali-Schöll  198 Susanna Palkonen  199 Peter Panzner  200 Hae-Sim Park  201 Jean-Louis Pépin  202   203 Ana-Maria Pereira  204   205 Oliver Pfaar  206 Ema Paulino  207 Jim Phillips  208 Robert Picard  53 Davor Plavec  209   210 Ted A Popov  211 Fabienne Portejoie  1 David Price  212   213 Emmanuel P Prokopakis  214 Benoit Pugin  3 Filip Raciborski  58 Rojin Rajabian-Söderlund  215 Sietze Reitsma  3   33 Xavier Rodo  13 Antonino Romano  216   217 Nelson Rosario  218 Menahenm Rottem  219 Dermot Ryan  220 Johanna Salimäki  221 Mario M Sanchez-Borges  222 Juan-Carlos Sisul  223 Dirceu Solé  224 David Somekh  225 Talant Sooronbaev  226 Milan Sova  227 Otto Spranger  120 Cristina Stellato  112 Rafael Stelmach  228 Charlotte Suppli Ulrik  229 Michel Thibaudon  230 Teresa To  231 Ana Todo-Bom  154 Peter V Tomazic  232 Antonio A Valero  233 Rudolph Valenta  234   235   236 Marylin Valentin-Rostan  237 Rianne van der Kleij  238   239 Olivier Vandenplas  240 Giorgio Vezzani  241 Frédéric Viart  92 Giovanni Viegi  242   243 Dana Wallace  244 Martin Wagenmann  245 De Y Wang  246 Susan Waserman  247 Magnus Wickman  248 Dennis M Williams  249 Gary Wong  250 Piotr Wroczynski  71 Panayiotis K Yiallouros  251   252 Arzu Yorgancioglu  253 Osman M Yusuf  254 Heahter J Zar  255   256 Stéphane Zeng  257 Mario Zernotti  258 Luo Zhang  259 Nan S Zhong  260 Mihaela Zidarn  261 ARIA Study GroupMASK Study Group
Collaborators, Affiliations
Free PMC article
Review

Next-generation ARIA Care Pathways for Rhinitis and Asthma: A Model for Multimorbid Chronic Diseases

J Jean Bousquet et al. Clin Transl Allergy. .
Free PMC article

Abstract

Background: In all societies, the burden and cost of allergic and chronic respiratory diseases are increasing rapidly. Most economies are struggling to deliver modern health care effectively. There is a need to support the transformation of the health care system into integrated care with organizational health literacy.

Main body: As an example for chronic disease care, MASK (Mobile Airways Sentinel NetworK), a new project of the ARIA (Allergic Rhinitis and its Impact on Asthma) initiative, and POLLAR (Impact of Air POLLution on Asthma and Rhinitis, EIT Health), in collaboration with professional and patient organizations in the field of allergy and airway diseases, are proposing real-life ICPs centred around the patient with rhinitis, and using mHealth to monitor environmental exposure. Three aspects of care pathways are being developed: (i) Patient participation, health literacy and self-care through technology-assisted "patient activation", (ii) Implementation of care pathways by pharmacists and (iii) Next-generation guidelines assessing the recommendations of GRADE guidelines in rhinitis and asthma using real-world evidence (RWE) obtained through mobile technology. The EU and global political agendas are of great importance in supporting the digital transformation of health and care, and MASK has been recognized by DG Santé as a Good Practice in the field of digitally-enabled, integrated, person-centred care.

Conclusion: In 20 years, ARIA has considerably evolved from the first multimorbidity guideline in respiratory diseases to the digital transformation of health and care with a strong political involvement.

Keywords: ARIA; Care pathways; Health care transformation; MASK; POLLAR; Rhinitis.

Conflict of interest statement

Competing interestsDr. Ansotegui reports personal fees from Mundipharma, Roxall, Sanofi, MSD, Faes Farma, Hikma, UCB, Astra Zeneca, outside the submitted work. Dr. Bosnic-Anticevich reports grants from TEVA, personal fees from TEVA, Boehringer Ingelheim, AstraZeneca, Sanofi, Mylan, outside the submitted work. Dr. Bousquet reports personal fees and others from Chiesi, Cipla, Hikma, Menarini, Mundipharma, Mylan, Novartis, Sanofi-Aventis, Takeda, Teva, Uriach, others from Kyomed, outside the submitted work. Dr. Boulet reports and Disclosure of potential conflicts of interest—last 3 years. Research grants for participation to multicentre studies, AstraZeneca, Boston Scientific, GlaxoSmithKline, Hoffman La Roche, Novartis, Ono Pharma, Sanofi, Takeda. Support for research projects introduced by the investigator AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck, Takeda. Consulting and advisory boards Astra Zeneca, Novartis, Methapharm. Royalties Co-author of “Up-To-Date” (occupational asthma). Nonprofit grants for production of educational materials AstraZeneca, Boehringer-Ingelheim, GlaxoSmithKline, Merck Frosst, Novartis. Conference fees AstraZeneca, GlaxoSmithKline, Merck, Novartis. Support for participation in conferences and meetings Novartis, Takeda. Other participations Past president and Member of the Canadian Thoracic Society Respiratory Guidelines Committee; Chair of the Board of Directors of the Global Initiative for Asthma (GINA). Chair of Global Initiative for Asthma (GINA) Guidelines Dissemination and Implementation Committee; Laval University Chair on Knowledge Transfer, Prevention and Education in Respiratory and Cardiovascular Health; Member of scientific committees for the American College of Chest Physicians, American Thoracic Society, European Respiratory Society and the World Allergy Organization; 1st Vice-President of the Global Asthma Organization “InterAsma”. Dr. Casale reports grants and non-financial support from Stallergenes, outside the submitted work. Dr. Cruz reports grants and personal fees from GlaxoSmithKline, personal fees from Boehrinher Ingelheim, AstraZeneca, Novartis, Merk, Sharp & Dohme, MEDA Pharma, EUROFARMA, Sanofi Aventis, outside the submitted work. Dr. Ebisawa reports personal fees from DBV Technologies, Mylan EPD maruho, Shionogi & CO., Ltd., Kyorin Pharmaceutical Co., Ltd., Thermofisher Diagnostics, Pfizer, Beyer, Nippon Chemifar, Takeda Pharmaceutical Co., Ltd., MSD, outside the submitted work. Dr. Ivancevich reports personal fees from Euro Farma Argentina, Faes Farma, non-financial support from Laboratorios Casasco, outside the submitted work. Dr. Haahtela reports personal fees from Mundipharma, Novartis, and Orion Pharma, outside the submitted work. Dr. Klimek reports grants and personal fees from ALK Abelló, Denmark, Novartis, Switzerland, Allergopharma, Germany, Bionorica, Germany, GSK, Great Britain, Lofarma, Italy, personal fees from MEDA, Sweden, Boehringer Ingelheim, Germany, grants from Biomay, Austria, HAL, Netherlands, LETI, Spain, Roxall, Germany, Bencard, Great Britain, outside the submitted work. V.KV has received payment for consultancy from GSK and for lectures from StallergensGreer, Berlin-CHemie and sponsorship from MYLAN for in the following professional training: ARIA masterclass in allergic rhinitis participation. Dr. Larenas Linnemann reports personal fees from GSK, Astrazeneca, MEDA, Boehringer Ingelheim, Novartis, Grunenthal, UCB, Amstrong, Siegfried, DBV Technologies, MSD, Pfizer., grants from Sanofi, Astrazeneca, Novartis, UCB, GSK, TEVA, Chiesi, Boehringer Ingelheim, outside the submitted work. Dr. Mösges reports personal fees from ALK, grants from ASIT biotech, Leti, BitopAG, Hulka, Ursapharm, Optima; personal fees from allergopharma, Nuvo, Meda, Friulchem, Hexal, Servier, Bayer, Johnson & Johnson, Klosterfrau, GSK, MSD, FAES, Stada, UCB, Allergy Therapeutics; grants and personal fees from Bencard, Stallergenes; grants, personal fees and non-financial support from Lofarma; non-financial support from Roxall, Atmos, Bionorica, Otonomy, Ferrero; personal fees and non-financial support from Novartis; Dr. Okamoto reports personal fees from Eizai Co., Ltd., Shionogi Co., Ltd., Torii Co., Ltd., GSK, MSD, Kyowa Co., Ltd., grants and personal fees from Kyorin Co., Ltd., Tiho Co., Ltd., grants from Yakuruto Co., Ltd., Yamada Bee Farm, outside the submitted work. Dr. Papadopoulos reports grants from Gerolymatos, personal fees from Hal Allergy B.V., Novartis Pharma AG, Menarini, Hal Allergy B.V., outside the submitted work. Dr. Pépin reports grants from AIR LIQUIDE FOUNDATION, AGIR à dom, ASTRA ZENECA, FISHER & PAYKEL, MUTUALIA, PHILIPS, RESMED, VITALAIRE, other from AGIR à dom, ASTRA ZENECA, BOEHRINGER INGELHEIM, JAZZ PHARMACEUTICAL, NIGHT BALANCE, PHILIPS, RESMED, SEFAM, outside the submitted work. Dr. Pfaar reports grants and personal fees from ALK-Abelló, Allergopharma Stallergenes Greer, HAL Allergy Holding B.V./HAL Allergie GmbH, Bencard Allergie GmbH/Allergy Therapeutics, Lofarma, grants from Biomay, ASIT Biotech Tools S.A, Laboratorios LETI/LETI Pharma, Anergis S.A., grants from Nuvo, Circassia, Glaxo Smith Kline, personal fees from Novartis Pharma, MEDA Pharma, Mobile Chamber Experts (a GA2LEN Partner), Pohl-Boskamp, Indoor Biotechnologies, grants from, outside the submitted work. Dr. Todo-Bom reports grants and personal fees from Novartis, Mundipharma, GSK Teva Pharma, personal fees from AstraZeneca, grants from Leti, outside the submitted work. Dr. Tsiligianni reports advisory boards from Boehringer Ingelheim and Novartis and a grant from GSK, outside the submitted work. Dr. Wallace reports and Indicates that she is the co-chair of the Joint Task Force on Practice Parameters, a task force composed of 12 members of the American Academy of Allergy, Asthma, and Immunology and the American College of Allergy, Asthma, and Immunology. Dr. Waserman reports other from CSL Behring, Shire, AstraZeneca,Teva, Meda, Merck, outside the submitted work. Dr. Zuberbier reports and Organizational affiliations: Commitee member: WHO-Initiative “Allergic Rhinitis and Its Impact on Asthma” (ARIA). Member of the Board: German Society for Allergy and Clinical Immunology (DGAKI). Head: European Centre for Allergy Research Foundation (ECARF). Secretary General: Global Allergy and Asthma European Network (GA2LEN). Member: Committee on Allergy Diagnosis and Molecular Allergology, World Allergy Organization (WAO).

Figures

Fig. 1
Fig. 1
Organizations supporting the meeting
Fig. 2
Fig. 2
ICPs for rhinitis and asthma multimorbidity (adapted from [102])
Fig. 3
Fig. 3
Next-generation ICPs for rhinitis and asthma multi-morbidity
Fig. 4
Fig. 4
Embedding aerobiology and air pollution in ICPs

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