Oppenheimer J, Slade DJ, Hahn BA, Zografos L, Gilsenan A, Richardson D, McSorley D, Lima R, Molfino NA, Averell CM. Real-world evidence: patient views on asthma in respiratory specialist clinics in America. Ann Allergy Asthma Immunol. 2021 Apr;126(4):385-93. doi: 10.1016/j.anai.2020.12.015.


BACKGROUND: Approximately 30–50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. Data on prevalence and burden of uncontrolled asthma in specialty settings is lacking.

OBJECTIVE: To assess prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the US.

METHODS:
Adults with physician-diagnosed asthma attending pulmonary/allergy clinics with self-reported ICS use in the previous 4 weeks completed an electronic questionnaire including the Asthma Control Test (ACT) and St George’s Respiratory Questionnaire (SGRQ). Additional information was collected using an electronic case report form.

RESULTS: Of 774 patients attending 12 pulmonary and 12 allergy clinics, 53% were not well controlled (mean [standard deviation; SD] ACT: 14.3 [3.6] vs 22.4 [1.6] in well-controlled patients). Among ICS/LABA users, 56% were not well controlled, which increased with increasing ICS dose (low-dose 45.7%; high-dose 59.7%). The not well-controlled group reported more respiratory illnesses, more comorbidities, and poorer health-related quality of life (mean [SD] SGRQ: 46.1 [18.9] vs 19.8 [12.9] in the well-controlled group). These patients also had more asthma exacerbations (≥1 exacerbation: 68.9% vs 43.1%) and increased healthcare resource utilization (≥1 asthma-related hospitalization: 10.7% vs 2.7%); 27.3% were also receiving systemic corticosteroids. Approximately 40% of the population were eligible for step-up to ICS/LABA/long-acting muscarinic antagonist triple therapy, and 20% were eligible for biologic therapy.

CONCLUSION: Substantial unmet needs exist among patients with inadequately controlled asthma managed in US specialist settings, which may be addressed by improved patient/physician education, better guideline implementation and improved adherence.

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