Characteristics of Adult Severe Refractory Asthma in Korea Analyzed From the Severe Asthma Registry

Abstract

PurposeAlthough mild to moderate asthma is much more common, the morbidity and mortality of severe asthma are much higher. This study was performed to identify and analyze the clinical characteristics of severe asthma in Korea.MethodsWe registered patients with severe refractory asthma into the Severe Asthma Registry supported by the Severe Asthma Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology. Patients were enrolled since 2010 from the 15 university hospitals nationwide in Korea. Severe asthma was defined according to modified European Respiratory Society/American Thoracic Society criteria. Information on demographics, medical history, pulmonary function tests and skin prick tests was collected; the clinical characteristics of severe asthmatics were analyzed from the collected data.ResultsA total of 489 patients were enrolled with a mean age of 62.3; 45% are male. Sixty percent of patients received Global Initiative for Asthma step 4 treatment, and 30% received step 5 treatment. The most common comorbidities were allergic rhinitis (58.7%). Aspirin hypersensitivity was observed in 14.0%. Approximately half (53.9%) are non-smokers. Atopy was proven in 38.5% of the patients. Regarding asthma medications, inhaled corticosteroids and long-acting β-agonist combination inhalers were most commonly prescribed (96.5%), followed by leukotriene antagonists (71.0%). A recombinant anti-immunoglobulin E monoclonal antibody (omalizumab) has been used in 1.8% of the patients. The mean forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC were 78.7%, 67.5% and 67.9% of predicted values, respectively. The mean Asthma Control Test and quality of life questionnaire scores were 16.5 out of 25 and 59.5 out of 85, respectively.ConclusionsThe baseline characteristics of severe asthma patients in the Korea Severe Asthma Registry were analyzed and reported for the first time. With this cohort, further prospective studies should be performed to search for ways to improve management of severe refractory asthma.

Severe asthma and eligibility for biologics in a Brazilian cohort

“…In the current study, patients with SA as per the modified ERS/ATS 2014 criteria were predominantly female, overweight/obese, in the 5th decade of life, with mean age of onset of symptoms at 15 years, confirming an older population with long-lasting asthma. Our cohort is therefore comparable to other SA cohorts (22)(23)(24), where the mean age of patients with SA was also over 50 years. A recent cross-sectional review of the ProAR cohort compared all subjects using different classification criteria, and reclassified patients according to ATS 2000 severe asthma criteria (11), criteria proposed to WHO in 2010 and ERS/ATS criteria 2014.…”

“…This study showed a higher proportion of patient (78%) that had at least one asthma exacerbation in the previous year. Indeed, the literature also points to a high number of SA patients experiencing exacerbations in other cohorts, with 41% to 83% of SA patients reporting at least one exacerbation in the last year in these studies (22)(23)(24)28,32). Although the frequency reported varied among studies, probably because of methodological differences and definition of exacerbations, all studies report that these patients are experiencing a high frequency of exacerbations, highlighting what is still an unmet need for these patients.…”

Challenges faced in managing adult asthma: A perspective from Asian countries

“…Average annual use of oral steroids has been estimated at 10.5 treatment episodes per patient. 15 In the Korean Severe Asthma Registry, chronic OCS use was found to be 18% among those in GINA step 4 or 5 treatment levels 45 as compared to Taiwanese severe asthmatic patients, where the rate of OCS prescriptions in the previous year reached almost 50%. 46 While robust data regarding the ongoing use of OCS is lacking, it can be safely concluded that the burden of OCS use in our population is high.…”

Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma

“… 20 In the Korean Severe Asthma Registry, 60.1% of patients at GINA step 5 took OCS continuously. 21 A population-based matched cohort study from Korea revealed that long-term use of SCS was associated with an increased mortality risk in a dose-dependent manner in patients with asthma. 22 Moreover, quantitative studies reported that exacerbation of asthma and long-term OCS-use negatively impacted professional life and made maintaining a normal life challenging.…”