## 3 Results of the Survey
### Management of Adult Patients with Asthma in the ED at the Time of COVID-19 Pandemic
#### 3.2.4 Hospitalization and Discharge of Asthmatic Patients during COVID-19 Disease
Visits should be scheduled at proper time intervals, prioritizing patients with a clear need for in-person consultation. Among them, special attention should be given to patients recently discharged from the ED and/or the hospital, recovering from asthma exacerbation episodes, or with severe symptoms despite adequate chronic treatment. Close and effective collaboration between ED physicians and pulmonologists is crucial for a multidisciplinary asthma approach and for setting up a fast track aimed to guarantee timely specialist respiratory management once the acute phase of the disease has resolved. Such a prompt clinical assessment is critical to achieving optimal disease control and preventing new acute exacerbations, with a consequent ED overstay and overcrowding [82]. Guidelines [2; 4] recommend arranging early follow-up after any exacerbation, within 2-7 days for adults. All patients should be followed regularly until symptoms are controlled and lung function returns to normal. At each follow-up visit, it is important to review modifiable risk factors, reliever and controller medications, inhaler techniques, patient self-monitoring, adherence, patient concerns and the short- and long-term asthma action plan [2; 4]. Moreover, asthma patients need to obtain lung function measures by spirometry at least every 1 to 2 years. The timing of follow-up should be personalized according to patients' needs. It can be arranged every 2 to 6 weeks while the patient gains symptom control, every 1 to 6 months to monitor symptom control, every 3 months if asthma is well controlled, and a step down in therapy is needed, to reduce inhaled corticosteroids. Thereafter, it should be performed every 6 months for patients with well-controlled asthma [83; 84]. In our opinion, concomitant SARS-CoV-2 infection does not change the scheduled follow-up period, which should occur, as described above, according to the patient's needs and symptoms. On the other hand, the recommendation to maintain social distancing and reschedule any non-essential visit and procedure has provided several opportunities for the expansion of electronic health, a novel approach defined as \"an emerging field at the intersection of medical informatics, public health and business, referring to health services and information delivered or enhanced through the internet and related technologies\". E-health encompasses a wide variety of subdomains such as telemedicine, digital apps, mobile health, virtual healthcare teams, electronic health records (EHRs), medication trackers and clinical decision support systems. Specifically, telemedicine refers to the use of telecommunications and information technology (IT), with the aim of providing easier and personalized health assessment, including diagnosis, management, consultation and information from distance. Although technological improvements in the recent past have dramatically increased the accessibility and quality of medical care through digital media, this process has accelerated further in the context of the ongoing COVID-19 pandemic. Telemedicine has the potential to improve the quality of care and adherence to therapy and allow early detection of disease worsening through continuous monitoring and real-time feedback to patients. Telemedicine strategies have been shown to be effective in the management of a range of chronic diseases, including asthma, by enabling patient empowerment and behavior changes [85, 86]. Moreover, there is a growing demand from patients to use electronic-based solutions to deal with their diseases. Potential additional benefits of telemedicine include cost reduction and social distancing [4, 5]. Through a reshaped outpatient asthma clinic healthcare, some tools could also be used for a triage process, assisting physicians to differentiate COVID-19 symptoms from those due to the common cold and asthma.