Management of patients with type 2 inflammatory diseases
Patients who present with a primary type 2 inflammatory disease should be asked about symptoms related to other type 2 inflammatory comorbid diseases (Table 1). Biomarkers, such as eosinophils and IgE in addition to FeNO for asthma, should be used in the clinical assessment of the status of type 2 inflammation, and it would be useful to have validated biomarkers of type 2 inflammation relevant to atopic dermatitis.
Consensus was not achieved on whether, from the patient perspective, the combined symptoms related to multiple moderate type 2 inflammatory diseases may be more burdensome compared with the symptoms of a single severe type 2 inflammatory disease. At the virtual meeting, the experts highlighted that disease burden can be assessed only by the patient. In addition, patients with a single severe type 2 inflammatory disease may be eligible for effective treatments to alleviate their symptoms, which may not be available for patients with multiple moderately severe type 2 inflammatory diseases. Where clinical settings allow it, specialists should work together when managing patients with highly complex cases of multiple concurrent type 2 inflammatory diseases.
Although consensus was achieved regarding the most serious cases taking priority in multidisciplinary team conferences, it was not agreed that some patients with multiple concurrent, refractory, moderate type 2 inflammatory diseases may benefit from having their cases discussed in this setting. At the virtual meeting, the experts highlighted the cost of organising multidisciplinary team conferences as a potential barrier to these patients being discussed in this manner and said that patients with severe disease should be given priority.

Impact on the holistic care of patients with type 2 inflammatory diseases

In the dermatologists’ breakout session, it was noted that some dermatologists in the Nordic region ask their patients about asthma but not about upper-airway symptoms or eosinophilic esophagitis. This is partly due to the limited time available for consultations but also stems from difficulties in assessing the severity of other comorbidities. A detailed knowledge of respiratory disease, for example, is not traditionally part of the dermatology specialty. It was noted that patient-reported outcome tools should be developed to assess the severity of comorbidities so that patients can be referred to an appropriate specialist. In addition, the importance of patient education to promote awareness of multi-organ disease was highlighted.
A key challenge highlighted by the dermatologists was the identification of patients with multi-organ disease even though patients may not mention non-dermatological comorbidities to their dermatologist. All participants agreed that a question guide would be useful to identify comorbidities proactively and facilitate appropriate holistic care for patients with type 2 inflammatory diseases.
Following the proposals in the dermatologists’ breakout session, all specialties involved in this initiative contributed to the preliminary draft of a question guide (Table 4), intended as an indication of scope. It is anticipated that the questions would be rephrased in appropriate patient-friendly language and undergo validation with patient groups prior to clinical use.
In the pulmonologists and paediatricians’ breakout session, it was noted that there may not be as much overlap between type 2 inflammatory diseases as the literature suggests. This may be because specialist clinics mostly see patients with severe and complex diseases, who are more likely to have type 2 inflammation-driven multi-organ disease, rather than patients who have milder disease(s). Ideally, a multidisciplinary team would discuss the optimal management and care of patients with type 2 inflammation-driven multi-organ disease, but the participants recognised the geographic and economic challenges associated with this approach.
In the breakout session that included the ENT, internal medicine, clinical immunology and allergy specialists, it was noted that patients with severe asthma and CRSwNP often experience overlapping symptoms. Therefore, the development of a composite score to holistically assess the severity of symptoms in patients with severe asthma and CRSwNP was recommended.