Severe Asthma Patients Experience and Satisfaction with Virtual Clinics in a Large Tertiary Care Hospital During COVID-19 Period

Background: Enforced social distancing (i.e. lockdowns) greatly facilitated control of COVID-19. Whilst access to hospitals was restricted, outpatient care continued remotely. At our institute, the biologic therapy for severe asthma patients is administered on-site by specialist nurses who follow manufacturers' recommendations. Aim: The aim of this study was to determine the satisfaction of patients with severe asthma with telemedicine, and the impact of COVID-19 lockdown on their receipt of biologics and other treatments for asthma. Methods: A crosssectional survey of 58 patients with severe asthma scheduled to receive biologic therapy at our hospital during the lockdown was performed with ethical approval. Results: Fifty-four patients participated (F 37;mean age 46.7 years;response rate 93.1%). Meantime since diagnosis was 19.2 years (SD 11.5 years). All had been on biologic therapy Omalizumab (45), Mepolizumab (7), or Dupilumab (2) for over three months (mean 38.4 months ± SD 26.5 months). Fifty (92.6%) had telephone follow-up, 31 (57.4%) were satisfied with telemedicine, 45 (81.4%) agreed that biologic therapy improved their asthma, and 40 (74.1%) received scheduled biologic therapy. Of the 45 patients living in the city, nine did not receive biologic therapy, two cited the lockdown as the reason for this;two did not receive an appointment;two did not perceive any benefit;2 had other reasons. Five of the nine patients living outside the city did not receive biologic therapy, 3 because of the lockdown, and 1 for fear of acquiring COVID-19. Alarmingly, 16 (29.6%) suggested that they had insufficient medications, and 27 (50%) reported difficulty obtaining medications. Conclusions: Many patients were satisfied with telemedicine, so this could be used to deliver routine outpatient tertiary care post-pandemic. However, logistics around supplying medications, and biologics must be considered in plans preparing for the second wave of COVID-19.