Severe and uncontrolled asthma in China: a cross-sectional survey from the Australasian Severe Asthma Network

Abstract

Background: Severe asthma is largely unexplored in the Chinese population. Patients with asthma underwent systematic evaluation, by investigating the characteristics of uncontrolled asthma and of asthma treated with three different controller therapies. Methods: This multi-centre, real-world study was conducted from March 2014 to September 2015. Adults with stable asthma underwent assessment of medication use, asthma control, quality of life, psychological symptoms, work productivity and activity impairment, bronchodilator response and sputum induction. Results: Participants (n=379) had a mean (SD) age of 47.4 (14.0) years, and 57.0% were female. There were 14.8% (n=56) of patients receiving treatment with Step 4/5 as severe asthma, but only 13 (3.4%) met ERS/ATS severe refractory asthma criteria. The patients with severe asthma usually used triple controller therapy: ICS/LABA, additional leukotriene modifier or theophylline, and reported better asthma control.Two fifths of patients (n=147) had uncontrolled asthma, with worse symptoms, psychological symptoms (both Conclusions: Although there is a relatively low proportion of severe refractory asthma based on ERS/ATS criteria, two of five patients with asthma in China are uncontrolled, displaying more psychological symptoms and reduced work productivity. Substantial gain in asthma control is obtained by triple controller therapy and this may be a promising therapeutic option for persistent asthma.

Working while unwell: Workplace impairment in people with severe asthma

“…3 The severe asthma registry from China reported similar rates of employment and higher levels of presenteeism in patients with uncontrolled compared with controlled asthma (85.2% vs. 47.5% presenteeism, respectively). 23 Comparable findings have been observed in severe asthma clinics, 24 outpatient clinics 25 and from population-based representative random samples, although these studies typically include few participants on high-dose medication. 14,[26][27][28][29] Studies assessing asthma-specific impairment, rather than general health impairment, also show that those with severe or uncontrolled asthma show greater impairment than controlled asthma.…”

“…Presenteeism, or “pushing through” at work to keep up with others, has been identified as a problem by severe asthma interviewees . The severe asthma registry from China reported similar rates of employment and higher levels of presenteeism in patients with uncontrolled compared with controlled asthma (85.2% vs. 47.5% presenteeism, respectively) . Comparable findings have been observed in severe asthma clinics, outpatient clinics and from population‐based representative random samples, although these studies typically include few participants on high‐dose medication .…”

Depressive symptom‐associated IL‐1β and TNF‐α release correlates with impaired bronchodilator response and neutrophilic airway inflammation in asthma

“…Our study has considerable strengths; it exhibited a higher comparability between asthmatics with and without depressive symptoms because of the consecutive recruitment of asthma participants from a real‐world setting, in which methods of assessment including lung function testing and sputum induction and processing were operated via standard procedures by the ASAN programme . In addition, sputum differential cell counts were performed by two well‐trained laboratory researchers, and the results exhibited an almost perfect agreement.…”

“…This was a cross‐sectional study based on the Australasian Severe Asthma Network (ASAN) . The ASAN provided the requirements of data collection and sputum induction and performed quality control of the source data.…”

“…Socio‐demographic data and baseline asthma information including medications and adherence, asthma history, the Asthma Control Questionnaire (ACQ), Asthma Quality of Life Questionnaire (AQLQ) and dyspnoea intensity (Modified Borg Scale, MBS) were collected. Peripheral venous blood was gathered, and sputum induction and skin‐prick testing for atopy were performed as described in our previous studies …”