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

Abstract

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.

The Experience of Living with Severe Asthma, Depression and Anxiety: A Qualitative Art-Based Study

“…Our results are similar to results of a drawing study in asthma, 15 where aspects/perceptions of strength and empowerment were depicted. These artistic representations align with the value people with severe asthma place on improving overall QoL, as reported in a study by Clark et al 30 Overall improvements in QoL may be dependent on coping strategies employed by people with severe asthma. 25 The use of negative language or language that indicates struggle (as observed in SA+D/A, Table 3 ) may be seen as an indication of their circumstance and sizeable disease burden.…”

“… 26 , 29 Importantly, Clark et al sought to determine outcomes of importance to people with severe asthma, with participation in activities rated among the most important priorities. 30 This gives insight into how greatly patients’ lives are affected and suggests precision assessment of severe asthma including mental health should occur in severe asthma clinics. 31 …”

Using a knowledge translation framework to identify health care professionals’ perceived barriers and enablers for personalised severe asthma care

“…Interestingly a similar pattern of insights was obtained from people with severe asthma themselves wherein they reported lack of awareness and self-management and poor treatment adherence as barriers to correct and timely diagnosis of severe asthma [ 37 ]. This highlights the importance of understanding the drivers of patient behaviour change [ 35 ] including trade-off preferences [ 38 ] for developing effective personalised strategies to promote medication adherence in severe asthma [ 35 ]. In a scoping review on barriers and facilitators to medication adherence, patient desired for more open communication and better information [ 34 ].…”

Oral corticosteroids stewardship for asthma in adults and adolescents: A position paper from the Thoracic Society of Australia and New Zealand

“…Despite these concerns, there was an acceptance of OCS treatment and they stated, 'but it keeps me breathing'. 125 The importance of OCS reduction was highlighted in a cross-sectional study by the same group, 126 who sought to understand the outcomes that patients wanted to improve F I G U R E 5 Natural frequency diagram highlighting the prevalence of high cumulative dose oral corticosteroid exposure in asthma. Based on data from studies by Hew et al 23 following initiation of add-on asthma treatments for severe asthma.…”