Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study

Abstract

Objectives: Severe asthma (SA) can be uncontrolled despite guideline-directed treatment. We described SA characteristics and identified factors associated with uncontrolled disease and frequent exacerbations. Methods: Post hoc analysis of the observational IDEAL study (201722/NCT02293265) included patients with SA aged !12 years receiving high-dose inhaled corticosteroids plus additional controller(s) for !12 months. Uncontrolled SA was defined by Asthma Control Questionnaire (ACQ)-5 scores !1.5 or !1 exacerbations (prior year), and further stratified by exacerbation frequency (no/infrequent [0-1] vs frequent [!2]; prior year); associated factors were determined using multivariate logistic regression. Results: Of 670 patients with SA, 540 (81%) were uncontrolled (ACQ-5 scores !1.5: 80%; !1 exacerbations [prior year]: 71%). Uncontrolled patients had lower lung function and worse health-related quality of life (HRQoL) than controlled patients; 197/540 (37%) experienced frequent exacerbations (prior year). Worse St George's Respiratory Questionnaire (SGRQ) total score, comorbid sinusitis, or eczema were significantly associated with uncontrolled SA; younger age, never smoker status, exacerbation requiring hospitalization (previous year), worse SGRQ symptom score, comorbid nasal polyps, COPD, or osteoporosis were significantly associated with uncontrolled SA with frequent exacerbations. Conclusions: In IDEAL, one-fifth of patients with SA were controlled, based on symptoms. Uncontrolled, exacerbating SA was associated with specific comorbidities, frequent exacerbations, a lower lung function, and compromised HRQoL, although inference from this analysis is limited by the selective cross-sectional nature of the cohort. Nonetheless, these data highlight the need for more effective precision treatments in this population.

Severe Asthma in a General Population Study: Prevalence and Clinical Characteristics

“…In our sample, those with severe asthma had better lung function compared with existing studies which show a mean FEV 1 between 60-72% of predicted, 3,7,8,16,26,27,34 with some higher reports at 77-81% of predicted. 5,25 Most of these studies used clinical samples and generally a higher cut-off for ICS dose, which indicates a higher severity of symptoms.…”

“…A British study that also included GINA step 4-users in their sample of potential severe asthma, showed only a marginally smaller prevalence than in our study, at 8% among asthmatics. 16 Prevalence of uncontrolled asthma varies among samples categorized as severe asthma, from 30-57% 5,6,[13][14][15]27 up to 90-100%, 7,8,12,25,26 and the variation is likely dependent on each study's design and the definition of asthma control. A previous study based on WSAS data, reported prevalence of signs of asthma severity (at 13-36% among asthmatics), but did not include a specific ICS dose in the definition of severity.…”

“…[3][4][5] They also have lower asthma control, quality of life and lung function despite high doses of ICS. 3,[6][7][8] As the severity of asthma increases, so do the costs for society, 9,10 and severe uncontrolled asthma accounts for 60% of all asthma costs. 11 The current definition by the European Respiratory Society/American Thoracic Society (ERS/ATS) primarily uses medication levels to distinguish severe asthma from other asthma.…”

Response to Mepolizumab Treatment in Patients with Severe Eosinophilic Asthma and Atopic Phenotypes

“…15 Exacerbations in turn have a substantial impact on health-related quality of life for patients with severe asthma, and are associated with considerable healthcare costs. [16][17][18] Therefore, it is important to select an appropriate add-on therapy to help reduce exacerbations and remain uncontrolled on other biologics, including omalizumab. Indeed, a recent study found that in patients with severe eosinophilic asthma and an overlapping allergic phenotype who were uncontrolled with omalizumab therapy, switching from omalizumab to mepolizumab was associated with clinically significant improvements in asthma control, health status and exacerbation rate, with no new safety issues reported.…”

Health-Related Quality of Life and Productivity Among US Patients with Severe Asthma

“…Our findings are consistent with those of the Identification and Description of sEvere Asthma patients in a cross-sectionaL (IDEAL) study, a recent, multinational real-world study of patients with SA. In the IDEAL study, patients who had uncontrolled asthma based on exacerbations and the Asthma Control Questionnaire had worse work productivity and HRQoL by SGRQ than those with controlled asthma, 24 with absolute scores similar to those observed in the CHRONICLE cohort. Both studies also demonstrated that work impairment from SA is primarily driven by productivity impairment while working (ie, presenteeism) rather than absenteeism.…”