Background: While sedentary behaviour has been shown to be associated with adverse health outcomes for people with asthma, limited research has been done on how to improve sedentary behaviour in this population. We aimed to obtain key stakeholders' perspectives on what is important to reduce sedentary time in people with severe asthma. Methods: Adults with severe asthma and their carers were invited to participate in a nominal group technique session. Participants volunteered strategies they considered important for optimising sedentary behaviour (reducing sedentary time and/or breaking up prolonged sedentary bouts). Following this, participants were instructed to identify the 10 most important strategies and rank these from most (10 points) to least (1 point) important. The 10 strategies that scored the highest proportion of the total possible score across all nominal group technique sessions were reported, and two independent researchers identified and deductively coded behaviour change techniques (BCTs) within these strategies. Results: Twenty participants attended one of five nominal group technique sessions. Severe asthma participants (n = 17) had a mean age (SD) of 69.9 (8.7) years, and self-reported spending a mean (SD) 7(3) hours per day sedentary. Carers (n = 3) had a mean (SD) age of 57.3 (21.0) years and self-reported a mean (SD) of 5 (2) hours of sedentary time per day. A total of 116 individual strategies were volunteered. With a weighted score of 8.3 (out of 10), "have a reminder or timer to minimise sedentary behaviour" was the highest weighted scored strategy. A total of 13 BCTs were coded to the list of the 10 highest weighted scored strategies. Conclusions: This study identified strategies important to people living with severe asthma and their carers for reducing time spent in sedentary behaviour. These strategies were coded to BCTs and can inform the design of future interventions to optimise sedentary behaviour. Future research should evaluate the effectiveness and feasibility of implementing these strategies.

Background and objective Asthma remains a significant burden on health systems and individuals, with many hospitalisations in Australia considered preventable through improved management and community care. This study aimed to explore end-user perspectives on preventing potentially avoidable asthma hospitalisations and identify key themes, research questions and priorities. Methods This cross-sectional study involved administering an anonymous online survey as part of a national asthma research priority-setting initiative. The participants included people living with asthma, their carers, healthcare professionals, and policymakers in Australia, all of whom were asked to provide free-text responses regarding the research questions they considered important for preventing asthma hospitalisations. Responses underwent thematic and content analysis to identify themes. Results Of the 554 respondents, 461 (83%) were individuals living with asthma, primarily females aged 45-64 years. The analysis identified nine key themes; however, subgroup analysis revealed four dominant themes: 1) self-management support, focusing on increasing knowledge and confidence, awareness of when to seek help, and the use of digital health tools; 2) pharmacological approaches, seeking better medication options with minimal side-effects; 3) strategies for avoiding major asthma events, emphasising improved proactive measures to reduce asthma attacks; 4) asthma care, highlighting the need to make medications more affordable, and enhanced access to care. Conclusions This study highlights key research priorities from the collective voice of end-users on preventing potentially avoidable asthma-related hospitalisations. These novel data provide a foundation for future research aimed at supporting Asthma Australia's vision to reduce asthma-related hospitalisations by 50% by 2030.

BACKGROUND:Asthma and vocal cord dysfunction (VCD), also known as inducible laryngeal obstruction (ILO), may coexist, resulting in worse outcomes for patients. The experience of people with VCD/ILO and coexisting asthma is unknown. OBJECTIVE:We sought to determine whether coexistent VCD/ILO and asthma have deleterious impacts on quality of life. METHODS:We undertook a descriptive qualitative study using one-to-one semistructured interviews with 30 purposively recruited adult participants with a prior confirmed doctor asthma diagnosis and laryngoscopy-confirmed VCD/ILO. A thematic and content analysis was conducted to explore the data. RESULTS:Participants were mostly female (63%), mean ± SD age 63 ± 12 years. Four themes were identified: trapped voice, altered life, knowledge about VCD/ILO, and looking for solutions. Participants reported their voice being trapped in their throat or the voice being suddenly cut off when talking or singing. Self-reported VCD/ILO symptoms including throat tightness and breathlessness were highlighted by participants. The second theme described how patients struggle to communicate or tended to shorten conversations. Insufficient knowledge and existing confusion regarding whether asthma was causing the breathlessness was described in the third theme. Looking for solutions depicted participants' diagnostic journey and how they sought an explanation for the symptoms. CONCLUSIONS:People with asthma and coexisting VCD/ILO experience a substantial burden affecting the quality of life. These data describe the impact on patients with coexisting conditions and should be used to increase clinician awareness of the experience of VCD/ILO from patients' perspectives to support a personalized approach to care.

Background Disabling symptoms of asthma including breathlessness, cough, wheeze and chest tightness largely impact quality of life; however, how these symptoms impact people with asthma of different severity levels remains unknown. This study aimed to compare and characterise patients' symptom experience and the burden caused, their quality of life, and the medication preferences of people with severe asthma against those of people with mild-to-moderate asthma. Methods This was a multisite qualitative study involving two focus groups and semistructured interviews of adults with severe asthma undertaken in Australia and UK. Interviews were also undertaken in people with mild-to-moderate asthma. Audio recordings were transcribed and analysed thematically. Results Participants in both severe asthma and mild-to-moderate asthma groups had a mean± sd age of 57±12 years. Between the severe asthma and mild-to-moderate asthma groups, 62% of participants were female and 86% lived with family. Themes were identified: 1) what is asthma and most bothersome symptoms: both groups reported breathlessness as the most bothersome symptom; 2) impacts on life: disease-related impact differed as people with severe asthma reported significant burden in their quality of life, which encompassed emotional, physical, social and financial wellbeing; and 3) personalised and responsive care: severe asthma interviewees preferred injectable biological therapy as a mode of treatment administration. Conclusions People with asthma are burdened by breathlessness and cough and other disabling symptoms resulting in impaired quality of life. Understanding the experiences of people with asthma of different severities can improve the patient–clinician partnership.

Abstract People with severe asthma often lead sedentary lifestyles, which adversely affects overall health and asthma-specific outcomes. To inform future sedentary behaviour- interventions, this study aimed to explore perceptions of sedentary behaviour among people with severe asthma. Adults (≥ 18 years) with severe asthma (n = 21) participated in face-to-face interviews. Participants were asked open-ended questions about factors influencing their sitting behaviour. A thematic analysis was conducted on phrases and sentences relevant to sedentary behaviour. Participants were predominantly females (62%), with controlled asthma (median [Q1, Q3]: ACQ6 0.5 [0.2,1.8]) and receiving monoclonal antibody therapy (71%). Almost half of the participants were not meeting the physical activity guidelines (47%) and were sedentary (10.8 [9.7, 11.4] hours of sedentary behaviour per day). The analysis generated four main themes: (1) Sedentary behaviour often stems from habits and routines, (2) Asthma and associated health issues contribute to sedentary behaviour, (3) Participants’ responsibilities influence their activity levels, and; (4) Participants’ conscious balance between being physically active and sedentary. The results of this qualitative study offers insights into the perspectives of people with severe asthma regarding sedentary behaviour, highlighting the identification of strategies that can be implemented to improve sedentary behaviour in this population.

As a novel respiratory viral infection, coronavirus disease 2019 (COVID-19) has influenced asthma in unpredictable ways. In the post-COVID era, there is a need to review asthma care and the new challenges and opportunities that are presented. Long COVID is a new and complex syndrome that has arisen. Treatable traits (TTs) have already been developed to address complex asthma and can be adapted to manage long COVID. Consumers are seeking more information on and answers to what to expect with a dual diagnosis of asthma and COVID-19. People with asthma identify a strong need for research into COVID and asthma. Completion of a national survey (n = 593) resulted in a list of research themes. From these, participants prioritized 10 asthma research themes. Among the top 10 asthma research priorities, the theme of COVID and asthma was ranked as the second priority in the overall rank list. Addressing these issues has the potential to improve global asthma health.

Background:Older people with Class II or III obesity and comorbidities experience complex care needs with frequent hospital admissions. In 2019/20 the National Health Service in England reported a 17% increase in hospital admissions of patients with obesity compared to 2018/19. Gaps in care for this population have been identified.Purpose:The purpose of this study was to understand the experiences and perspectives of healthcare professionals delivering non-surgical care to older people with Classes II or III obesity admitted to a tertiary care hospital.Methods:Healthcare professionals delivering non-surgical care to older people admitted with Class II or III obesity with comorbidities were recruited from an Australian tertiary referral hospital. Qualitative semi-structured interviews were conducted with 24 healthcare professionals from seven disciplines between August and December 2019. The interviews were audio-recorded, transcribed, and reviewed by participants for accuracy. Thematic inductive data analysis was deductively mapped to the Theoretical Domains Framework (TDF).Results:Four major themes of Barriers, Facilitators, Current Practice, and Recommendations and 11 subthemes were identified and mapped to nine domains in the TDF. The Barriers subtheme identified perceived patient related factors, health system issues, and provider issues, while the Facilitators subtheme included a patient centred approach, knowledge, and resources in the subacute setting. The major Current Practice theme explored factors influencing clinical management, and the Recommendations subthemes included engaging patients, access to quality care, education and support, and obesity as a chronic disease.Conclusion:This novel application of the TDF provided broad insights related to the barriers and facilitators in delivering non-surgical care to this hospital population, from the perspective of healthcare professionals. Understanding how these barriers interact can provide strategies to influence behaviour change and assist in the development of a holistic multidisciplinary model of care.

Background and ObjectivePeople living with asthma, their carers, clinicians and policymakers are the end-users of research and need research that address their individual healthcare needs. We aimed to understand the research priorities of end-users of asthma research. MethodsA national cross-sectional mixed-methods study was conducted. The study included an online survey that engaged patients, carers, healthcare professionals and policymakers to provide statements to free-text questions about what they would like to see answered by research to improve living with asthma on a day-to-day basis. Responses where thematically analysed followed by three online priority setting consensus workshops. ResultsThere were 593 respondents who provided 1446 text comments. Participants prioritized 10 asthma research themes which were: (1) asthma in children, (2) COVID 19 and asthma, (3) asthma care and self-management, (4) diagnosis and medication, (5) managing asthma attacks, (6) causes, prevention and features of asthma, (7) mental health, (8) asthma and ageing, (9) severe asthma, (10) asthma and other health conditions. Each theme comprises specific research questions. ConclusionThis project successfully established 10 priority research themes for asthma, reflecting the collective voice of the end-users of this research. These novel data can be used to address the documented mismatch in research prioritization between the research community and the end-users of research.

BACKGROUND:Low-dose long-term azithromycin is recommended in clinical practice guidelines for obstructive airway diseases (OAD); however, an optimal therapeutic regimen is not yet established.AIM:To understand the patterns of azithromycin use in OAD, characterise the patients who received it and evaluate its safety and efficacy using real-world data.METHODS:We audited 91 patients who had received azithromycin for at least 4 weeks for the management of asthma, chronic obstructive pulmonary disease (COPD) or non-cystic fibrosis bronchiectasis.RESULTS:The mean age was 65 ± 18 years, 60% were female and 48% were ex-smokers. The majority had asthma (75%), either alone (50%) or in combination with COPD (12%) or bronchiectasis (13%). Most (64%) reported cough or sputum at baseline. The most common treatment regimen was azithromycin 250 mg daily (73%) for more than 1 year (57%), with only seven adverse events. There was a significant reduction in the proportions of patients requiring emergency department visits (48% vs 32%; P < 0.001) and hospital admissions (35% vs 31%; P < 0.001) after starting azithromycin. In 88% of cases, physicians favoured the use of azithromycin.CONCLUSION:Physicians are currently using low-dose azithromycin for a long duration of more than 1 year for the management of OAD. The typical case definition is an older non-smoking adult with persistent asthma, often in combination with another OAD and presenting with bothersome cough or sputum. Azithromycin was well tolerated and led to reduced healthcare utilisation. Further research is required to establish an optimal dosage regimen of azithromycin in OAD.

Background Whilst multidimensional assessment enables the detection of treatable traits in severe asthma and has the potential to improve patient outcomes, healthcare disparities exist, and little is known about the factors influencing optimal management in severe asthma. This study aimed to explore perceived barriers, and enablers to implementing personalised care in severe asthma, from the healthcare professionals’ perspective. Methods A descriptive, qualitative study involving a single focus group (n = 7) and semi-structured interviews (n = 33) with multidisciplinary healthcare professionals involved in severe asthma care was conducted. A hybrid thematic and content analysis was undertaken to identify themes, which were then deductively mapped to the Theoretical Domains Framework (TDF). Results Overall, three emergent themes were identified: (1) Barriers- (2) Enablers- to optimal management; (3) Desired model of care. Across all TDF domains, 6 constructs influenced development and implementation of optimal care: (1) belief about consequences, (2) environmental context and resources, (3) belief about capabilities, (4) social/professional role and identity, (5) goals and (6) knowledge. Conclusion Implementation of personalised care in severe asthma is complex and non-linear. The use of a theory-based approach effectively demonstrated how a variety of behaviours could be targeted to optimise and promote personalised care in different clinical setting.