Living well with severe asthma

Stubbs, Michelle; Clark, Vanessa; McDonald, Vanessa M.

doi:10.1183/20734735.0165-2019

Cited by 29 publications

(26 citation statements)

References 61 publications

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“…Impairments in quality-of-life have been consistently illustrated among people with severe asthma, and has largely remained unchanged over the past decade [17,18,26,27]. The majority of patients in this study were already prescribed a mAb therapy, nonetheless, this did not reduce their endorsement of wanting better quality-of-life or fewer attacks, indicating that while these medications are known to improve these asthma outcomes, patients still see room for further improvement.…”

Section: Discussionmentioning

confidence: 71%

What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance

2020

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IntroductionThere is an increasing number of new therapies for severe asthma, however what outcomes people with severe asthma would like improved and what aspects they prioritise in new medications remain unknown. This study aimed to understand what outcomes are important to patients when prescribed new treatments and to determine the characteristics of importance to patients in their choice of asthma treatments.MethodsParticipants with severe asthma (n=50) completed a cross-sectional survey that ranked 17 potential hypothetical outcomes of treatment using a seven point Likert scale, as well as selecting their top five overall outcomes. Participants also completed hypothetical scenarios trading off medication characteristics for four hypothetical add-on asthma treatments.ResultsParticipants (58% male), had a mean (sd) age of 62.2 (13.5) years. Their top three prioritised outcomes were: to improve overall quality-of-life (selected by 83% of people), reduce number and severity of asthma attacks (72.3%), and being able to participate in physical activity (59.6%) When trading off medication characteristics the majority of patients with severe asthma chose the hypothetical medication with the best treatment efficacy (68%). However, a subgroup of patients prioritised the medications side effect profile and mode of delivery to select their preferred medication.ConclusionPeople with severe asthma value improved quality-of-life as an important outcome of treatment. Shared decision-making discussions between clinicians and patients that centre around medication efficacy and side effect profile can incorporate patient preferences for add-on therapy in severe asthma.

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Section: Discussionmentioning

confidence: 71%

What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance

2020

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“…Exacerbation of asthma also increases individuals’ risk of hospitalization and death, and impair quality of life. 2 , 3 Patients with moderate-to-severe asthma may have Type 2 inflammation driven by inflammatory cytokines IL-4, IL-13, and IL-5. 4 These patients are often identified by their treatment responsiveness to inhaled or oral corticosteroids (OCS) with or without atopic comorbidities.…”

Section: Asthma Prevalence and Therapeutic Inertiamentioning

confidence: 99%

Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary

Sico¹,

Oberle²,

Thomas

et al. 2021

PPA

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Moderate-to-severe asthma represents about a quarter of the nearly 10% of Americans diagnosed with asthma. Many patients with moderate-to-severe asthma have uncontrolled symptoms that lead to exacerbations requiring oral corticosteroids. There are many factors contributing to poor asthma control, including poor adherence to prescribed therapies, the under-prescribing of biologics and therapeutic inertia. We convened an eight-member panel from fields of primary care, pulmonology, immunology, health services and clinical research, behavioral science and pharmaceutical medical affairs, with the goal of identifying contributing factors and solutions to therapeutic inertia with asthma biologics. We used the Capability, Opportunity, and Motivation (COM-B) model to classify patient and provider behavior towards therapeutic inertia. The model incorporates existing behavior theories and is driven by the interaction of capability, opportunity, and motivation. We used a Delphi method to identify and develop six primary solutions: 1) integration of patient-centered outcomes into asthma management practice; 2) provider education about asthma treatment; 3) moderate-to-severe asthma care delivery redesign; 4) harmonized, evidence-based protocol for the management of moderate-to-severe asthma; 5) designated coordinator approach for optimal asthma management; and 6) a case coordination digital support tool. Integration of patient-centered outcomes into asthma management practice and provider education were identified as having the highest potential to impact therapeutic and clinical inertia. The COM-B model is effective in identifying improvement within therapeutic inertia targeting the capabilities, opportunities, and motivations of patients, providers, and payer systems.

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“…Severe asthma is a high burden disease with an increased risk of morbidity and mortality, [1][2][3][4] and is associated with quality-of-life impairment. 5,6 The burden of severe asthma pervades throughout many aspects of life, leading to impairments across physical, emotional, economic and social domains. 5,7,8 Confounding the treatment of severe asthma is the heterogeneous nature of the disease, with its variable response to treatment, multiple comorbidities and risk factors.…”

Section: Introductionmentioning

confidence: 99%

“…5,6 The burden of severe asthma pervades throughout many aspects of life, leading to impairments across physical, emotional, economic and social domains. 5,7,8 Confounding the treatment of severe asthma is the heterogeneous nature of the disease, with its variable response to treatment, multiple comorbidities and risk factors. 9 In recent years, the emergence of add-on therapies for severe asthma has improved clinical outcomes for some people with severe asthma.…”

Section: Introductionmentioning

confidence: 99%

The Patients’ Experience of Severe Asthma Add-On Pharmacotherapies: A Qualitative Descriptive Study

Clark¹,

Gibson²,

McDonald³

2021

JAA

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Purpose: Add-on therapies for severe asthma are continually emerging with proven efficacy in randomised controlled trials. To date, however, there are no qualitative studies exploring patients' experiences with these treatments. We aimed to understand the experience of patients who were treated with an add-on therapy for their severe asthma. Patients and Methods: A qualitative descriptive study was conducted, participants were recruited from the respiratory clinics and databases of a tertiary referral hospital. Participants with treatment-refractory severe asthma (n=20) prescribed an add-on therapy for >4 months (75% mepolizumab; 25% omalizumab, and 25% macrolide) were recruited. Qualitative semistructured interviews were conducted, with interviews thematically analysed. Results: Participants' mean (SD) age was 59.5 (15.3) years, and 50% were male. Participants reported 4.5 (2.3) exacerbations in the past year. Asthma Control Questionnaire score was 2.0 (1.4). The monoclonal add-on therapies had been prescribed for a median (IQR) of 12.5 (7.0, 24.0) months. Experience was captured in four emergent themes: "Life is just easier" provided an overall message that the add-on therapy made the participants' life easier in terms of increasing participation, levelling out symptoms, providing more energy and reducing healthcare use. "Prednisone: A necessary evil" was discussed, particularly in terms of dose and dependence and damaging side effects. The theme "worry and hope for the future" referenced treatment nonresponse or cessation of effect which was discussed by some participants. Finally, "holistic care" was centred on the sentiment that the participant's asthma management and overall health were not related to one aspect or medication alone. Conclusion: Patients with severe asthma experience vast improvements in quality-of-life and life participation with add-on therapies, but there remains a significant burden related to oral corticosteroids and incomplete treatment responses. Addressing this residual burden is an important area for future research.

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Living well with severe asthma

Cited by 29 publications

References 61 publications

What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance

What matters to people with severe asthma? Exploring add-on asthma medication and outcomes of importance

Therapeutic Inertia in Prescribing Biologics for Patients with Moderate-to-Severe Asthma: Workshop Summary

The Patients’ Experience of Severe Asthma Add-On Pharmacotherapies: A Qualitative Descriptive Study

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