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• W2892953206 abstract "Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline by using the best approach to integrated care pathways using mobile technology in patients with allergic rhinitis (AR) and asthma multimorbidity. The proposed next phase of ARIA is change management, with the aim of providing an active and healthy life to patients with rhinitis and to those with asthma multimorbidity across the lifecycle irrespective of their sex or socioeconomic status to reduce health and social inequities incurred by the disease. ARIA has followed the 8-step model of Kotter to assess and implement the effect of rhinitis on asthma multimorbidity and to propose multimorbid guidelines. A second change management strategy is proposed by ARIA Phase 4 to increase self-medication and shared decision making in rhinitis and asthma multimorbidity. An innovation of ARIA has been the development and validation of information technology evidence-based tools (Mobile Airways Sentinel Network [MASK]) that can inform patient decisions on the basis of a self-care plan proposed by the health care professional. Allergic Rhinitis and its Impact on Asthma (ARIA) has evolved from a guideline using the best approach1Shekelle P.G. Woolf S.H. Eccles M. Grimshaw J. Clinical guidelines: developing guidelines.BMJ. 1999; 318: 593-596Crossref PubMed Scopus (1005) Google Scholar, 2Bousquet J. Van Cauwenberge P. Khaltaev N. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334Abstract Full Text Full Text PDF PubMed Scopus (2162) Google Scholar, 3Brozek J.L. Bousquet J. Baena-Cagnani C.E. Bonini S. Canonica G.W. Casale T.B. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010; 126: 466-476Abstract Full Text Full Text PDF PubMed Scopus (1187) Google Scholar, 4Padjas A. Kehar R. Aleem S. Mejza F. Bousquet J. Schunemann H.J. et al.Methodological rigor and reporting of clinical practice guidelines in patients with allergic rhinitis: QuGAR study.J Allergy Clin Immunol. 2014; 133: 777-783.e4Abstract Full Text Full Text PDF PubMed Scopus (27) Google Scholar, 5Brozek J.L. Bousquet J. Agache I. Agarwal A. Bachert C. Bosnic-Anticevich S. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines—2016 Revision.J Allergy Clin Immunol. 2017; 140: 950-958Abstract Full Text Full Text PDF PubMed Scopus (897) Google Scholar to integrated care pathways (ICPs) using mobile technology in patients with AR and asthma multimorbidity.6Bousquet J. Hellings P.W. Agache I. Bedbrook A. Bachert C. Bergmann K.C. et al.ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle.Clin Transl Allergy. 2016; 6: 47Crossref PubMed Scopus (114) Google Scholar The term comorbidity is commonly used for allergic diseases, but multimorbidity might be more appropriate. Comorbidity is the presence of 1 or more additional diseases co-occurring with a primary disease or the effect of such additional disorders or diseases. Multimorbidity is a term that means co-occurring diseases in the same patient.7Bousquet J. Anto J.M. Wickman M. Keil T. Valenta R. Haahtela T. et al.Are allergic multimorbidities and IgE polysensitization associated with the persistence or re-occurrence of foetal type 2 signalling? The MeDALL hypothesis.Allergy. 2015; 70: 1062-1078Crossref PubMed Scopus (80) Google Scholar, 8Anto J.M. Bousquet J. Akdis M. Auffray C. Keil T. Momas I. et al.Mechanisms of the Development of Allergy (MeDALL): introducing novel concepts in allergy phenotypes.J Allergy Clin Immunol. 2017; 139: 388-399Abstract Full Text Full Text PDF PubMed Scopus (118) Google Scholar ARIA provides an evidence-based approach for managing the patient's needs, but real-life data have shown that few patients use guidelines and that they often self-medicate (Menditto, in preparation). Moreover, patients largely use over-the-counter medications dispensed in pharmacies.9Carr W.W. Yawn B.P. Management of allergic rhinitis in the era of effective over-the-counter treatments.Postgrad Med. 2017; 129: 572-580Google Scholar, 10Lombardi C. Musicco E. Rastrelli F. Bettoncelli G. Passalacqua G. Canonica G.W. The patient with rhinitis in the pharmacy. A cross-sectional study in real life.Asthma Res Pract. 2015; 1: 4Google Scholar, 11Fromer L.M. Blaiss M.S. Jacob-Nara J.A. Long R.M. Mannion K.M. Lauersen L.A. Current Allergic Rhinitis Experiences Survey (CARES): consumers' awareness, attitudes and practices.Allergy Asthma Proc. 2014; 35: 307-315Crossref PubMed Scopus (21) Google Scholar Self-care and shared decision making (SDM) centered around the patient should be used more frequently. Change is inevitable in health care. ARIA has followed a change management (CM) strategy in the past, but a new revised plan should be considered to fill in the gaps of knowledge translation in practice and to increase the benefits of self-care in integrated care pathways (ICPs) by using the currently available information and communication technology tools.12Kotter J. Leading change. Harvard Business School Press, Boston1996Google Scholar These changes should prepare and support individuals, teams, and organizations in making organizational change centered around the patient for more efficient care. ARIA was initiated during a World Health Organization workshop in 19992Bousquet J. Van Cauwenberge P. Khaltaev N. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334Abstract Full Text Full Text PDF PubMed Scopus (2162) Google Scholar and has evolved in 4 phases. Phase 1 included development of an evidence-based document to provide a guide for the diagnosis and management of AR and asthma multimorbidity.1Shekelle P.G. Woolf S.H. Eccles M. Grimshaw J. Clinical guidelines: developing guidelines.BMJ. 1999; 318: 593-596Crossref PubMed Scopus (1005) Google Scholar, 2Bousquet J. Van Cauwenberge P. Khaltaev N. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334Abstract Full Text Full Text PDF PubMed Scopus (2162) Google Scholar In 2008, ARIA was updated using the same recommendation system.1Shekelle P.G. Woolf S.H. Eccles M. Grimshaw J. Clinical guidelines: developing guidelines.BMJ. 1999; 318: 593-596Crossref PubMed Scopus (1005) Google Scholar, 13Bousquet J. Khaltaev N. Cruz A.A. Denburg J. Fokkens W.J. Togias A. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen).Allergy. 2008; 63: 8-160Crossref PubMed Scopus (3693) Google Scholar ARIA has been disseminated and is implemented in more than 70 countries around the world.14Bousquet J. Schunemann H.J. Samolinski B. Demoly P. Baena-Cagnani C.E. Bachert C. et al.Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs.J Allergy Clin Immunol. 2012; 130: 1049-1062Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar For Phase 2, in its 2010 revision, ARIA was the first chronic respiratory disease guideline to adopt the Grading of Recommendation, Assessment, Development and Evaluation (GRADE) approach, an advanced evidence evaluation and recommendation methodology for guidelines.3Brozek J.L. Bousquet J. Baena-Cagnani C.E. Bonini S. Canonica G.W. Casale T.B. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010; 126: 466-476Abstract Full Text Full Text PDF PubMed Scopus (1187) Google Scholar, 5Brozek J.L. Bousquet J. Agache I. Agarwal A. Bachert C. Bosnic-Anticevich S. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines—2016 Revision.J Allergy Clin Immunol. 2017; 140: 950-958Abstract Full Text Full Text PDF PubMed Scopus (897) Google Scholar When guidelines are made using the same methodology, the recommendations are similar.5Brozek J.L. Bousquet J. Agache I. Agarwal A. Bachert C. Bosnic-Anticevich S. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines—2016 Revision.J Allergy Clin Immunol. 2017; 140: 950-958Abstract Full Text Full Text PDF PubMed Scopus (897) Google Scholar, 15Dykewicz M.S. Wallace D.V. Baroody F. Bernstein J. Craig T. Finegold I. et al.Treatment of seasonal allergic rhinitis: an evidence-based focused 2017 guideline update.Ann Allergy Asthma Immunol. 2017; 119: 489-511.e41Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar In Phase 3 ARIA focused on the implementation of emerging technologies for individualized and predictive medicine to develop ICPs for the management of AR and asthma by a multidisciplinary group centered around the patients (Mobile Airways Sentinel Network [MASK]).16Bousquet J. Bewick M. Arnavielhe S. Mathieu-Dupas E. Murray R. Bedbrook A. et al.Work productivity in rhinitis using cell phones: the MASK pilot study.Allergy. 2017; 72: 1475-1484Crossref PubMed Scopus (67) Google Scholar, 17Bousquet J. Caimmi D.P. Bedbrook A. Bewick M. Hellings P.W. Devillier P. et al.Pilot study of mobile phone technology in allergic rhinitis in European countries: the MASK-rhinitis study.Allergy. 2017; 72: 857-865Crossref PubMed Scopus (83) Google Scholar, 18Bousquet J. Onorato G.L. Bachert C. Barbolini M. Bedbrook A. Bjermer L. et al.CHRODIS criteria applied to the MASK (MACVIA-ARIA Sentinel NetworK) Good Practice in allergic rhinitis: a SUNFRAIL report.Clin Transl Allergy. 2017; 7: 37Crossref PubMed Scopus (36) Google Scholar, 19Caimmi D. Baiz N. Tanno L.K. Demoly P. Arnavielhe S. Murray R. et al.Validation of the MASK-rhinitis visual analogue scale on smartphone screens to assess allergic rhinitis control.Clin Exp Allergy. 2017; 47: 1526-1533Crossref PubMed Scopus (70) Google Scholar, 20Bousquet J. Arnavielhe S. Bedbrook A. Alexis-Alexandre G. Eerd Mv Murray R. et al.Treatment of allergic rhinitis using mobile technology with real world data: The MASK observational pilot study.Allergy. 2018; 73: 1763-1774Crossref PubMed Scopus (87) Google Scholar, 21Bousquet J. Arnavielhe S. Bedbrook A. Fonseca J. Morais Almeida M. Todo Bom A. et al.The Allergic Rhinitis and its Impact on Asthma (ARIA) score of allergic rhinitis using mobile technology correlates with quality of life: the MASK study.Allergy. 2018; 73: 505-510Crossref PubMed Scopus (70) Google Scholar, 22Bousquet J. Devillier P. Anto J.M. Bewick M. Haahtela T. Arnavielhe S. et al.Daily allergic multimorbidity in rhinitis using mobile technology: a novel concept of the MASK study.Allergy. 2018; 73: 1622-1631Crossref PubMed Scopus (58) Google Scholar, 23Bousquet J. VandenPlas O. Bewick M. Arnavielhe S. Bedbrook A. Murray R. et al.The Work Productivity and Activity Impairment Allergic Specific (WPAI-AS) questionnaire using mobile technology: the MASK study.J Investig Allergol Clin Immunol. 2018; 28: 42-44Crossref PubMed Scopus (30) Google Scholar The proposed ARIA Phase 4 is CM to provide an active and healthy lifestyle to patients with rhinitis and asthma across the lifecycle, irrespective of their sex or socioeconomic status, with the aim of reducing health and social inequities globally. In SDM both the patient and physician contribute to the medical decision-making process, placing the patient at the center of the decision-making paradigm.24Barry M.J. Edgman-Levitan S. Shared decision making--pinnacle of patient-centered care.N Engl J Med. 2012; 366: 780-781Crossref PubMed Scopus (2010) Google Scholar Physicians explain treatments and alternatives to patients, who then choose the treatment option that best aligns with their beliefs, lifestyles, and goals along with the benefits and risks.25Florin J. Ehrenberg A. Ehnfors M. Clinical decision-making: predictors of patient participation in nursing care.J Clin Nurs. 2008; 17: 2935-2944Crossref PubMed Scopus (56) Google Scholar In contrast to SDM, the traditional medical care system places physicians in a position of authority, with patients playing a passive role in care. Patients want greater involvement in SDM.26Guadagnoli E. Ward P. Patient participation in decision-making.Soc Sci Med. 1998; 47: 329-339Crossref PubMed Scopus (631) Google Scholar An innovation of SDM in ARIA is the use of information technology (IT) evidence-based tools that can inform patients' decisions based on a guided self-management plan proposed by their health care professionals.27Agency for Health Care resources (AHRQ)The CAHPS ambulatory care improvement guide. Practical strategies for improving patient experience. Strategy 61: shared decision making.https://www.ahrq.gov/cahps/quality-improvement/improvement-guide/6-strategies-for-improving/communication/strategy6i-shared-decisionmaking.htmlGoogle Scholar In asthmatic patients the effectiveness of 4 SDM studies shows improvement of control and some other parameters, but more studies are needed to confirm the data.28Kew K.M. Malik P. Aniruddhan K. Normansell R. Shared decision-making for people with asthma.Cochrane Database Syst Rev. 2017; 10: CD012330PubMed Google Scholar Change is inevitable in health care. However, many change projects fail because of varied beliefs and cultural circumstances, poor planning, unmotivated staff, deficient communication, or excessively frequent changes.29Barrow J.M. Toney-Butler T.J. Change, management. StatPearls, Treasure Island (FL)2017Google Scholar CM aims to prepare and support individuals, teams, and organizations in making organizational change. It proposes methods for redirecting or redefining resources, business processes, budget allocation, and/or modes of operation. When properly applied, CM significantly changes health care and its organization. However, health systems differ largely between countries or even regions, and a combination of CM with ICPs might be more relevant, allowing each organization to use the CM principles according to their needs and regulations. CM deals with different disciplines from health care, behavioral, and social sciences to IT and business solutions. Although theories might seem abstract and impractical for health care practice, they can help in planning solutions to common health care problems.29Barrow J.M. Toney-Butler T.J. Change, management. StatPearls, Treasure Island (FL)2017Google Scholar The Lewin 3-step model is widely used30Lewin K. Psychological ecology.in: Cartwright D. Field theory in social science. Social Science Paperbacks, London1943Google Scholar, 31Antwi M. Kale M. Change management in healthcare: literature review. Monieson Centre for Business Research in Healthcare, Queen's University. Canadian Electronic Library, Ottawa, Ontario2014Google Scholar: unfreezing, moving, and refreezing.31Antwi M. Kale M. Change management in healthcare: literature review. Monieson Centre for Business Research in Healthcare, Queen's University. Canadian Electronic Library, Ottawa, Ontario2014Google Scholar Lippitt et al32Lippitt R. Watson J. Westley B. The dynamics of planned change. Harcourt, Brace and World, New York1958Google Scholar and Kotter12Kotter J. Leading change. Harvard Business School Press, Boston1996Google Scholar have added intermediate steps (Table I).12Kotter J. Leading change. Harvard Business School Press, Boston1996Google Scholar, 29Barrow J.M. Toney-Butler T.J. Change, management. StatPearls, Treasure Island (FL)2017Google Scholar, 31Antwi M. Kale M. Change management in healthcare: literature review. Monieson Centre for Business Research in Healthcare, Queen's University. Canadian Electronic Library, Ottawa, Ontario2014Google Scholar, 32Lippitt R. Watson J. Westley B. The dynamics of planned change. Harcourt, Brace and World, New York1958Google Scholar, 33Lewin K. Defining the field at a given time.Psychol Rev. 1943; 50: 292Crossref Scopus (588) Google ScholarTable IExamples of planned change management modelsAdapted from Antwi et al.31Antwi M. Kale M. Change management in healthcare: literature review. Monieson Centre for Business Research in Healthcare, Queen's University. Canadian Electronic Library, Ottawa, Ontario2014Google ScholarLewin33Lewin K. Defining the field at a given time.Psychol Rev. 1943; 50: 292Crossref Scopus (588) Google ScholarKotter12Kotter J. Leading change. Harvard Business School Press, Boston1996Google ScholarLippitt et al32Lippitt R. Watson J. Westley B. The dynamics of planned change. Harcourt, Brace and World, New York1958Google ScholarUnfreezingStep 1: Establish a sense of urgencyStep 2: Create a guiding coalitionStep 3: Develop a vision and strategyPhase 1: Diagnose the problemPhase 2: Assess motivation and capacity for changePhase 3: Assess change agent's motivation and resourcesMovingStep 4: Communicate the change visionStep 5: Empower others to act on the visionStep 6: Generate short-term winsStep 7: Consolidate gains and produce more changePhase 4: Select a progressive change objectivePhase 5: Choose appropriate role of the change agentRefreezingStep 8: Anchor new approaches in the culture and institutionalize the changesPhase 6: Terminate the helping relationship Open table in a new tab Several models of organizational and personal change have been reviewed for respiratory diseases.34Stoller J.K. Implementing change in respiratory care.Respir Care. 2010; 55: 749-757PubMed Google Scholar Kotter's theory has been applied to different fields of medicine35Reddeman L. Foxcroft S. Gutierrez E. Hart M. Lockhart E. Mendelsohn M. et al.Improving the quality of radiation treatment for patients in Ontario: increasing peer review activities on a jurisdictional level using a change management approach.J Oncol Pract. 2016; 12: e61-e70PubMed Google Scholar, 36Burden M. Using a change model to reduce the risk of surgical site infection.Br J Nurs. 2016; 25: 949-955Google Scholar, 37Henry L.S. Christine Hansson M. Haughton V.C. Waite A.L. Bowers M. Siegrist V. et al.Application of Kotter's theory of change to achieve baby-friendly designation.Nurs Womens Health. 2017; 21: 372-382Abstract Full Text Full Text PDF Scopus (7) Google Scholar and pharmacies.38Teixeira B. Gregory P.A.M. Austin Z. How are pharmacists in Ontario adapting to practice change? Results of a qualitative analysis using Kotter's change management model.Can Pharm J (Ott). 2017; 150: 198-205Crossref PubMed Scopus (17) Google Scholar Guidelines, such as Global Initiative for Asthma (GINA),39Bateman E.D. Hurd S.S. Barnes P.J. Bousquet J. Drazen J.M. Fitzgerald M. et al.Global strategy for asthma management and prevention: GINA executive summary.Eur Respir J. 2008; 31: 143-178Crossref PubMed Scopus (2357) Google Scholar, 40Reddel H.K. Bateman E.D. Becker A. Boulet L.P. Cruz A.A. Drazen J.M. et al.A summary of the new GINA strategy: a roadmap to asthma control.Eur Respir J. 2015; 46: 622-639Crossref PubMed Scopus (578) Google Scholar Global Initiative for Lung Diseases,41Rodriguez-Roisin R. Rabe K.F. Vestbo J. Vogelmeier C. Agusti A. all previous and current members of the Science Committee and the Board of Directors of GOLD (goldcopd.org/committees/)Global Initiative for Chronic Obstructive Lung Disease (GOLD) 20th Anniversary: a brief history of time.Eur Respir J. 2017; 50Google Scholar, 42Vogelmeier C.F. Criner G.J. Martinez F.J. Anzueto A. Barnes P.J. Bourbeau J. et al.Global strategy for the diagnosis, management, and prevention of chronic obstructive lung disease 2017 report. GOLD Executive Summary.Am J Respir Crit Care Med. 2017; 195: 557-582Crossref PubMed Scopus (1946) Google Scholar EPOS (European Position Paper on Rhinosinusitis and nasal polyps),43Fokkens W.J. Lund V.J. Mullol J. Bachert C. Alobid I. Baroody F. et al.EPOS 2012: European position paper on rhinosinusitis and nasal polyps 2012. A summary for otorhinolaryngologists.Rhinology. 2012; 50: 1-12Crossref PubMed Google Scholar and ARIA,2Bousquet J. Van Cauwenberge P. Khaltaev N. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334Abstract Full Text Full Text PDF PubMed Scopus (2162) Google Scholar, 3Brozek J.L. Bousquet J. Baena-Cagnani C.E. Bonini S. Canonica G.W. Casale T.B. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010; 126: 466-476Abstract Full Text Full Text PDF PubMed Scopus (1187) Google Scholar, 13Bousquet J. Khaltaev N. Cruz A.A. Denburg J. Fokkens W.J. Togias A. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA2LEN and AllerGen).Allergy. 2008; 63: 8-160Crossref PubMed Scopus (3693) Google Scholar developed a CM strategy that was very effective and produced many updates and revisions while having a positive effect on clinical care and influencing research priorities. Most guidelines are condition specific, but ARIA was unique because it included, for the first time, the multimorbid component of airway diseases. Although it followed the patient's perspectives, epidemiologic evidence,44Leynaert B. Bousquet J. Neukirch C. Liard R. Neukirch F. Perennial rhinitis: an independent risk factor for asthma in nonatopic subjects: results from the European Community Respiratory Health Survey.J Allergy Clin Immunol. 1999; 104: 301-304Abstract Full Text Full Text PDF PubMed Scopus (420) Google Scholar and some supporting mechanistic studies,45Chanez P. Vignola A.M. Vic P. Guddo F. Bonsignore G. Godard P. et al.Comparison between nasal and bronchial inflammation in asthmatic and control subjects.Am J Respir Crit Care Med. 1999; 159: 588-595Crossref PubMed Scopus (176) Google Scholar this concept was not accepted by the leadership of GINA, who considered neither the asthma-rhinitis multimorbidity concept nor the benefit for the patients. The sense of urgency should identify and highlight the potential threats and repercussions that might arise in the future by examining the opportunities that can be tapped through effective interventions. In patients with AR and asthma, in the 1990s, the sense of urgency was to provide guidelines that could reduce both the burden of the disease and the mortality (in asthmatic patients). Although there were articles indicating the links between the upper and lower airways,46Simons F.E. Allergic rhinobronchitis: the asthma-allergic rhinitis link.J Allergy Clin Immunol. 1999; 104: 534-540Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar, 47Togias A. Rhinitis and asthma: evidence for respiratory system integration.J Allergy Clin Immunol. 2003; 111: 1171-1184Abstract Full Text Full Text PDF PubMed Scopus (376) Google Scholar the effect of rhinitis on asthma was not fully recognized, and ARIA was initiated to better recognize the interrelationships between the 2 diseases and to propose multimorbid guidelines. The ARIA Working Group was initiated during a World Health Organization meeting (December 1999) and evolved as a powerful group with 400 members in 70 countries.14Bousquet J. Schunemann H.J. Samolinski B. Demoly P. Baena-Cagnani C.E. Bachert C. et al.Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs.J Allergy Clin Immunol. 2012; 130: 1049-1062Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar Members have been working together for years and include all stakeholders needed for CM.1Shekelle P.G. Woolf S.H. Eccles M. Grimshaw J. Clinical guidelines: developing guidelines.BMJ. 1999; 318: 593-596Crossref PubMed Scopus (1005) Google Scholar, 6Bousquet J. Hellings P.W. Agache I. Bedbrook A. Bachert C. Bergmann K.C. et al.ARIA 2016: Care pathways implementing emerging technologies for predictive medicine in rhinitis and asthma across the life cycle.Clin Transl Allergy. 2016; 6: 47Crossref PubMed Scopus (114) Google Scholar The patient organization European Federation of Allergy and Airways Diseases Patients' Associations has always been an active member of ARIA. The ARIA vision has always been to provide a guide for the diagnosis and management of AR and asthma multimorbidity, including developing countries,1Shekelle P.G. Woolf S.H. Eccles M. Grimshaw J. Clinical guidelines: developing guidelines.BMJ. 1999; 318: 593-596Crossref PubMed Scopus (1005) Google Scholar, 2Bousquet J. Van Cauwenberge P. Khaltaev N. Allergic rhinitis and its impact on asthma.J Allergy Clin Immunol. 2001; 108: S147-S334Abstract Full Text Full Text PDF PubMed Scopus (2162) Google Scholar by using the best available evidence.3Brozek J.L. Bousquet J. Baena-Cagnani C.E. Bonini S. Canonica G.W. Casale T.B. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision.J Allergy Clin Immunol. 2010; 126: 466-476Abstract Full Text Full Text PDF PubMed Scopus (1187) Google Scholar, 5Brozek J.L. Bousquet J. Agache I. Agarwal A. Bachert C. Bosnic-Anticevich S. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines—2016 Revision.J Allergy Clin Immunol. 2017; 140: 950-958Abstract Full Text Full Text PDF PubMed Scopus (897) Google Scholar ARIA has established 2 major targets: the recognition and implementation of the asthma-rhinitis multimorbidity, as well as a new classification (intermittent-persistent and mild-to-moderate severe AR) to meet patients' expectations. Moreover, ARIA priorities have always included primary care physicians, pharmacists, and patients' organizations. One of the ARIA strengths has been to communicate its vision effectively worldwide. More than 1000 articles have been posted on PubMed from more than 50 countries by using the ARIA recommendations.14Bousquet J. Schunemann H.J. Samolinski B. Demoly P. Baena-Cagnani C.E. Bachert C. et al.Allergic Rhinitis and its Impact on Asthma (ARIA): achievements in 10 years and future needs.J Allergy Clin Immunol. 2012; 130: 1049-1062Abstract Full Text Full Text PDF PubMed Scopus (442) Google Scholar The number of training sessions in more than 70 countries cannot be counted. ARIA has been endorsed by many governments and international organizations: ARIA recommendations have been used for the labeling of allergen immunotherapy by the European Medicines Agency. Organizational processes and structures are in place and are aligned with the overall organizational vision. However, a continuous check is needed for barriers and for people who are resisting change. We have implemented proactive actions to remove the obstacles involved in the process of change. ARIA has been recognized as the major rhinitis and asthma multimorbidity guideline for years in most countries, except for the United States and Japan. However, the recent US guidelines are using the evidence-based approach of ARIA (GRADE), and the recommendations are similar15Dykewicz M.S. Wallace D.V. Baroody F. Bernstein J. Craig T. Finegold I. et al.Treatment of seasonal allergic rhinitis: an evidence-based focused 2017 guideline update.Ann Allergy Asthma Immunol. 2017; 119: 489-511.e41Abstract Full Text Full Text PDF PubMed Scopus (107) Google Scholar, 48Wallace D.V. Dykewicz M.S. Seasonal Allergic Rhinitis: A focused systematic review and practice parameter update.Curr Opin Allergy Clin Immunol. 2017; 17: 286-294Crossref PubMed Scopus (28) Google Scholar, 49Brozek J.L. Akl E.A. Alonso-Coello P. Lang D. Jaeschke R. Williams J.W. et al.Grading quality of evidence and strength of recommendations in clinical practice guidelines. Part 1 of 3. An overview of the GRADE approach and grading quality of evidence about interventions.Allergy. 2009; 64: 669-677Crossref PubMed Scopus (443) Google Scholar to those of ARIA.5Brozek J.L. Bousquet J. Agache I. Agarwal A. Bachert C. Bosnic-Anticevich S. et al.Allergic Rhinitis and its Impact on Asthma (ARIA) Guidelines—2016 Revision.J Allergy Clin Immunol. 2017; 140: 950-958Abstract Full Text Full Text PDF PubMed Scopus (897) Google Scholar The recent Japanese guidelines for AR are also creating bridges with ARIA.50Okubo K. Kurono Y. Ichimura K. Enomoto T. Okamoto Y. Kawauchi H. et al.Japanese guidelines for allergic rhinitis 2017.Allergol Int. 2017; 66: 205-219Abstract Full Text Full Text PDF PubMed Scopus (157) Google Scholar As proposed by Kotter,12Kotter J. Leading change. Harvard Business School Press, Boston1996Google Scholar creating short-term wins early in the change process instead of having a single long-term goal can produce a feeling of victory in the early stages of change, which will reinforce support for the strategy. The concept of asthma and rhinitis multimorbidity is now globally accepted in developed and developing countries.51Navarro A.M. Delgado J. Munoz-Cano R.M. Dordal M.T. Valero A. Quirce S. et al.Allergic respiratory disease (ARD), setting forth the basics: proposals of an expert consensus report.Clin Transl Allergy. 2017; 7: 16Crossr" @default.
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