Can severe asthmatic patients achieve asthma control? A systematic approach in patients with difficult to control asthma followed in a specialized clinic

Abstract

BackgroundDespite advances in asthma treatment, severe asthma (SA) still results in high morbidity and use of health resources. Our hypothesis was that SA patients would achieve adequate control with a systematic protocol, including oral corticosteroids, budesonide/formoterol maintenance and reliever therapy and a multidisciplinary approach to improve adherence.MethodsNon-controlled (NC) SA patients were enrolled to receive 2 weeks of oral corticosteroids and 12 weeks of formoterol + budesonide. Assessments included asthma control questionnaire (ACQ), asthma control test (ACT), daily symptom diary, lung function and health-related quality of life (HRQoL) questionnaires.ResultsOf 51 patients, 13 (25.5%) achieved control. NC patients had higher utilization of health resources and higher exacerbation rates. Both controlled (C) and NC patients had significantly reduced ACQ scores after oral corticosteroid treatment. After 12 weeks, C patients continued improving. NC patients did not have significant changes. A similar pattern was found regarding lung function, use of rescue medication, and days free of symptoms. After 2 weeks of oral corticosteroids, an increase occurred in those who achieved the ACQ cut off; however, 53.8% of C patients had an ACQ < 1.57 versus 21.1% of NC patients (p = 0.03). Both groups had low HRQoL at baseline with improvement after intervention.ConclusionsDespite rigorous, optimized follow-up treatment, 75% of SA patients did not achieve adequate symptom control and presented with impaired quality of life. Conversely, application of a low-cost, easy to implement systematic protocol can prevent up to 25% of SA patients from up-titrating to new and complex therapies, thus reducing costs and morbidity.Trial registrationRetrospectively registered at ClinicalTrial.gov on 22 February 2010 (NCT01089322).

Airway pathology in severe asthma is related to airflow obstruction but not symptom control

“…The study design is shown in Figure , and initial results of the study have been published elsewhere . Following a 2‐week run‐in period, uncontrolled severe asthmatics received 40 mg/d oral prednisone for 2 weeks, in addition to inhaled maintenance therapy with budesonide/formoterol 400/12 μg twice daily, and rescue budesonide/formoterol 200/6 μg as needed for 12 weeks.…”

“…We have recently reported that 25.5% of severe asthmatics achieved symptom control following a systematic protocol . This study provided us with a unique opportunity to investigate if airway inflammation and remodeling in severe asthmatics were related to symptom control and persistent airflow obstruction.…”

“…This study provided us with a unique opportunity to investigate if airway inflammation and remodeling in severe asthmatics were related to symptom control and persistent airflow obstruction. Therefore, our objective in the current manuscript was to describe several inflammatory and structural pathological features in bronchial biopsies that could be related to symptom control in a group of severe asthmatics . Furthermore, we hypothesized that persistent airflow obstruction would be associated with marked structural changes.…”

Phenotyping asthma: More complex than just age

“…The best strategy for weight loss is not yet clearly determined, although it is well recognized that it should be an important target in the treatment of these individuals . On the other hand, some phenotypes still lack an effective specific therapy although their recognition is related to a worse clinical prognosis such as in asthmatic patients with fixed airflow limitation …”

“…8 On the other hand, some phenotypes still lack an effective specific therapy although their recognition is related to a worse clinical prognosis such as in asthmatic patients with fixed airflow limitation. 9,10 Asthma is a heterogeneous and complex disease. Understanding the various pieces that make up this puzzle is fundamental for adequate clinical management and development of new therapies.…”