Asthma Case Collection

Question Title

* 1. Are you currently in clinical practice?

Yes

Question Title

* 2. How many patients with poorly controlled or difficult-to-treat asthma do you see on a weekly basis?

1-5

6-10

>10

Question Title

* 3. The remaining questions are regarding your patient case.
Please indicate your patient’s sex:

Male

Female

Question Title

* 4. Please indicate your patient’s age group:

0-5 years

6-11 years

12-17 years

≥18 years

Question Title

* 5. Does the patient have any of the following comorbidities? (Choose all that apply)

Atopic dermatitis

Food allergy

Allergic rhinitis

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* 6. How would you classify your patient’s asthma phenotype?

Eosinophilic

Neutrophilic

Mixed eosinophilic/neutrophilic

Allergic

Unknown

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* 7. How would you classify your patient’s endotype?

Th2 high

Th2 low

Unknown

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* 8. Is the patient currently on a biologic?

Yes

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* 9. Please provide a detailed description of your case, including past and current medication, relevant comorbidities, known laboratory values, and clinical assessment:

Question Title

* 10. If my case is selected for discussion, I can be contacted to provide additional HIPAA-compliant details, if necessary, to help elucidate the scenario for resolution by the expert faculty:

Yes

Asthma Case Collection

Question Title

* 1. Are you currently in clinical practice?

Question Title

* 2. How many patients with poorly controlled or difficult-to-treat asthma do you see on a weekly basis?

Question Title

* 3. The remaining questions are regarding your patient case.Please indicate your patient’s sex:

Question Title

* 4. Please indicate your patient’s age group:

Question Title

* 5. Does the patient have any of the following comorbidities? (Choose all that apply)

Question Title

* 6. How would you classify your patient’s asthma phenotype?

Question Title

* 7. How would you classify your patient’s endotype?

Question Title

* 8. Is the patient currently on a biologic?

Question Title

* 9. Please provide a detailed description of your case, including past and current medication, relevant comorbidities, known laboratory values, and clinical assessment:

Question Title

* 10. If my case is selected for discussion, I can be contacted to provide additional HIPAA-compliant details, if necessary, to help elucidate the scenario for resolution by the expert faculty:

Question Title

* 11. If yes, please provide the best contact method and information to reach you.

* 3. The remaining questions are regarding your patient case.
Please indicate your patient’s sex: