Real-World Assessment of Asthma Specialist Visits Among U.S. Patients with Severe Asthma

Most, Jessica; Ambrose, Christopher S.; Chung, Yen; Kreindler, James L.; Near, Aimee M.; Brunton, Stephen; Cao, Yao; Huang, Huan; Zhao, Xiaohui

doi:10.1016/j.jaip.2021.05.003

Cited by 14 publications

(11 citation statements)

References 23 publications

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“…Suboptimal adherence to guidelines is a common worldwide problem seen not only in asthma, 12–15 and in particular in severe asthma, 16 but also in chronic obstructive pulmonary disease and other common chronic conditions, such as cardiovascular diseases and diabetes. 17–21 Asthma reviews are known to be significantly associated with a reduced risk of severe asthma exacerbations.…”

Section: Discussionmentioning

confidence: 99%

Annual and Post-Exacerbation Follow-Up of Asthma Patients in Clinical Practice – A Large Population-Based Study in Sweden

Sandelowsky¹,

Ställberg²,

Wiklund³

et al. 2022

JAA

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Background Symptom control has not improved in Swedish asthma patients during the last two decades. Guidelines recommend annual reviews for asthma patients treated with maintenance inhaled corticosteroids (ICS). We aimed to describe how visit patterns in an ICS-treated asthma population in Sweden were related to applicable asthma guidelines. Methods Swedish electronic health data for incident asthma patients, ≥18 years, with at least one ICS collection (index date) between 2006 and 2017 were included. Exacerbations were defined as hospitalizations, emergency visits, or collection of oral corticosteroids (OCS). Probability of an asthma-related regular follow-up visit and probability of a follow-up visit after an exacerbation, both within 15 months, were estimated using the cumulative incidence function, time-to-event analysis, and incident rate ratios. Results In 51,349 asthma patients (mean age 47.6 years, 63% females), 17,573 had a regular asthma visit in primary or secondary care within 15 months after the index, yielding an overall probability of a visit of 37.4%. Patients with a follow-up visit had higher ICS collection and lower OCS collection than patients without regular visits. Among 22,097 patients with acute exacerbations, the probability of a visit within 15 months after an exacerbation was 31.0%. The probability of having a visit increased during the study period. Conclusion Only one-third of ICS-treated asthma patients, regardless of asthma severity, had a regular or post-exacerbation follow-up visit within a 15-month period. The consequences of this lack of adherence to guidelines need further evaluation to secure optimal asthma management.

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Section: Discussionmentioning

confidence: 99%

Annual and Post-Exacerbation Follow-Up of Asthma Patients in Clinical Practice – A Large Population-Based Study in Sweden

Sandelowsky¹,

Ställberg²,

Wiklund³

et al. 2022

JAA

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“…This includes patients who remain controlled despite maximally tolerated inhaled therapy, e.g., high-dose ICS with additional controllers or maintenance systemic corticosteroids. [1][2][3][4][5][6] Severe asthma leads to a higher burden of disease, including a greater risk for exacerbations and progressive decline in lung function as well as increased medication burden, poorer asthma control, and a lower quality of life compared with patients with less severe asthma or adults without asthma. [6][7][8][9] Frequent exacerbations are often managed by systemic corticosteroids, which can accumulate negative side effects.…”

Section: Introductionmentioning

confidence: 99%

“…While most patients' asthma can be well managed with low‐dose inhaled corticosteroids (ICS) and long‐acting β 2 ‐agonist (LABA) therapy, 5%–10% of patients have asthma that can be characterized as severe. This includes patients who remain controlled despite maximally tolerated inhaled therapy, e.g., high‐dose ICS with additional controllers or maintenance systemic corticosteroids 1‐6 . Severe asthma leads to a higher burden of disease, including a greater risk for exacerbations and progressive decline in lung function as well as increased medication burden, poorer asthma control, and a lower quality of life compared with patients with less severe asthma or adults without asthma 6‐9 .…”

Section: Introductionmentioning

confidence: 99%

Dupilumab sustains efficacy in patients with moderate‐to‐severe type 2 asthma regardless of inhaled corticosteroids dose

Pavord

Bourdin

Papi

et al. 2023

Allergy

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BackgroundDupilumab, a human monoclonal antibody, blocks the shared receptor component for interleukins‐4/13, key and central drivers of type 2 inflammation. The TRAVERSE (NCT02134028) open‐label extension study demonstrated the long‐term safety and efficacy of dupilumab in patients ≥12 years who completed a previous dupilumab asthma study. The safety profile was consistent with that observed in the parent studies. Here, we assess whether dupilumab sustains long‐term efficacy in patients regardless of inhaled corticosteroid (ICS) dose at parent study baseline (PSBL).MethodsPatients from phase 2b (NCT01854047) or phase 3 (QUEST; NCT02414854) studies receiving high‐ or medium‐dose ICS at PSBL and enrolled in TRAVERSE were included. We analyzed unadjusted annualized severe exacerbation rates, change from PSBL in pre‐bronchodilator (BD) forced expiratory volume in 1 second (FEV1), 5‐item asthma control questionnaire, and type 2 biomarkers in patients with type 2 asthma at baseline (blood eosinophils ≥150 cells/μL or fractional exhaled nitric oxide [FeNO] ≥25 ppb), and subgroups defined by baseline blood eosinophils or FeNO.ResultsOf patients with type 2 asthma (n = 1666), 891 (53.5%) were receiving high‐dose ICS at PSBL. In this subgroup, unadjusted exacerbation rates for dupilumab versus placebo were 0.517 versus 1.883 (phase 2b) and 0.571 versus 1.300 (QUEST) over the parent study (52 weeks) and remained low throughout TRAVERSE (0.313–0.494). Improvements in pre‐BD FEV1 were sustained throughout TRAVERSE. Similar clinical efficacy was observed among patients receiving medium‐dose ICS at PSBL and biomarker subgroups.ConclusionsDupilumab showed sustained efficacy for up to 3 years in patients with uncontrolled, moderate‐to‐severe type 2 asthma on high‐ or medium‐dose ICS.

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“…[3][4][5] However, poor asthma control is common, 6 and 60-80% of patients with sub-optimal disease control and/or possible severe asthma are managed in primary care. 4,5,7 As such, a large unmet need for improving asthma control exists. 6 Furthermore, significant socioeconomic and geographic barriers of entry exist in access to both specialist care and novel treatments such as biologics, 5,8,9 despite their favourable effects on asthma control and not least exacerbation rates.…”

Section: Introductionmentioning

confidence: 99%

“…6 Furthermore, significant socioeconomic and geographic barriers of entry exist in access to both specialist care and novel treatments such as biologics, 5,8,9 despite their favourable effects on asthma control and not least exacerbation rates. 7,10,11 Consequently, the question is not whether societal and individual burden can be reduced, but by how muchespecially when it comes to uncontrolled mild-to-moderate asthma.…”

Section: Introductionmentioning

confidence: 99%

Disease Control, Not Severity, Drives Job Absenteeism in Young Adults with Asthma – A Nationwide Cohort Study

Håkansson¹,

Backer²,

Ulrik³

2022

JAA

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The impact of asthma and disease control on job absenteeism in young adults is sparsely investigated and conflicting evidence exist. Based on a nationwide cohort, the present study aims to describe the overall job absenteeism across asthma severities and describe the possible influence of asthma control. Methods: REASSESS is a nationwide cohort of Danish asthma patients aged 18-45 using controller medication between 2014 and 2018, followed retrospectively for up to 15 years using national databases. Impact of asthma was investigated using negative binomial regression adjusted for age, sex, Charlson score and level of education and presented as adjusted incidence rate ratios with 95% confidence intervals. Results: A total of 60,534 patients with asthma (median age 33 (25, 39), 55% female, 19% uncontrolled disease and 5.7% possible severe asthma) were followed for 12.7 (6.5-14.8) years. The prevalence of any absenteeism was more common in both mild-to-moderate and possible severe asthma compared to the background population (67%, 80% and 62%, respectively; p < 0.0001). Compared to the background population, mild-to-moderate and possible severe asthma were more likely to have temporary sick leave (1

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Real-World Assessment of Asthma Specialist Visits Among U.S. Patients with Severe Asthma

Cited by 14 publications

References 23 publications

Annual and Post-Exacerbation Follow-Up of Asthma Patients in Clinical Practice – A Large Population-Based Study in Sweden

Annual and Post-Exacerbation Follow-Up of Asthma Patients in Clinical Practice – A Large Population-Based Study in Sweden

Dupilumab sustains efficacy in patients with moderate‐to‐severe type 2 asthma regardless of inhaled corticosteroids dose

Disease Control, Not Severity, Drives Job Absenteeism in Young Adults with Asthma – A Nationwide Cohort Study

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