Characterization of Severe Asthma Worldwide

Abstract

BACKGROUND: Clinical characteristics of the international population with severe asthma are unknown. Intercountry comparisons are hindered by variable data collection within regional and national severe asthma registries. We aimed to describe demographic and clinical characteristics of patients treated in severe asthma services in the United States, Europe, and the Asia-Pacific region. METHODS:The International Severe Asthma Registry retrospectively and prospectively collected data in patients with severe asthma ($ 18 years old), receiving Global Initiative for Asthma (GINA) Step 5 treatment or with severe asthma remaining uncontrolled at GINA Step 4. Baseline demographic and clinical data were collected from the United States, United Kingdom, South Korea, Italy, and the Severe Asthma Web-based Database registry (including Australia, Singapore, and New Zealand) from December 2014 to December 2017. RESULTS:We included 4,990 patients. Mean (SD) age was 55.0 (15.9) years, and mean (SD) age at asthma onset was 30.7 (17.7) years. Patients were predominantly female (59.3%) and white (72.6%), had never smoked (60.5%), and were overweight or obese (70.4%); 34.9% were at GINA Step 5; and 57.2% had poorly controlled disease. A total of 51.1% of patients were receiving regular intermittent oral corticosteroids, and 25.4% were receiving biologics (72.6% for those at GINA Step 5). Mean (SD) exacerbation rate was 1.7 (2.7) per year. Intercountry variation was observed in clinical characteristics, prescribed treatments, and biomarker profiles.CONCLUSIONS: Using a common data set and definitions, this study describes severe asthma characteristics of a large patient cohort included in multiple severe asthma registries and identifies country differences. Whether these are related to underlying epidemiological factors, environmental factors, phenotypes, asthma management systems, treatment access, and/ or cultural factors requires further study.

Evaluating the real-life effect of MP-AzeFlu on asthma outcomes in patients with allergic rhinitis and asthma in UK primary care

“…The patients frequently suffered from other co-morbid conditions in addition to AR, such as CRS, NP, and eczema, and tended to have late onset asthma. High co¼morbidity burden and late onset are features of severe asthma, 45 and indeed 13.1% of patients in our study had a confirmed diagnosis of severe asthma. This is likely an under-estimation; a recent analysis from the OPCRD showed that the majority of patients with severe asthma in primary care are 'hidden', and not referred to specialist care for a confirmed diagnosis.…”

“…Severe asthma was noted in 13.1% (n ¼ 156) of patients (defined as those on GINA Step 5 treatment or with uncontrolled asthma on GINA Step 4) and over a quarter of patients had !2 asthma consultations (excluding annual review visit) in the year prior to MP-AzeFlu prescription (Table 2). Furthermore, 45.8% (n ¼ 544) of patients had !1 acute respiratory event, and 37.7% (n ¼ 448) had !1 asthma exacerbation. Only 9.6% (n ¼ 58/604) of patients had controlled asthma (GINA definition) in the baseline year (Table 3).…”

Demographic and clinical patterns of severe asthma in the Middle East

“…reported the prevalence of nasal polyposis to be 7.3%. [ 13 ] Nasal polyposis has been reported to be associated with greater asthma severity;[ 39 ] hoever, we did not observe a significant difference in ACT scores between asthma patients with and without nasal polyps ( P = 0.5). Interestingly, we observed a significant difference in the prevalence of nasal polyposis between males and females ( P = 0.013), where males had a higher prevalence (56.9% vs. 43.1%, P = 0.013) which is in concordance with previously reported data.…”

“…Allergic rhinitis was the most prevalent comorbidity in our cohort (52.2%) as observed in other severe asthma cohorts. [ 10 13 ] Allergic rhinitis is well knon to coexist with asthma and according to some authors more than 80% of asthmatics have a diagnosis of allergic rhinitis. [ 26 ] In addition, the presence of allergic rhinitis is thought to be associated with increased asthma severity.…”

<p>Frequency of Tiotropium Bromide Use and Clinical Features of Patients with Severe Asthma in a Real-Life Setting: Data from the Severe Asthma Network in Italy (SANI) Registry</p>

“…Our study highlights that within the population of SANI registry, around one out of three patients were undergoing LAMA therapy; this is in line with what was reported by other national registries for severe asthma, with LAMA treatment being used in 13-45% of patients depending on the country. 32 That group was overall characterized by more severe disease in terms of lung function, exacerbations, patients' reported outcomes and required therapy; in fact, the prescription rate of biological agents, in particular anti-IL5 agents, and the use of systemic corticosteroids were higher in patients under LAMA therapy. Worthy of mention, the distribution of inflammatory biomarkers in that sub-population was very similar to the overall severe asthmatics population sample.…”