Anna von Bülow1, Vibeke Backer2, Uffe Bodtger3, Niels Ulrik Søes-Petersen4, Susanne Vest5, Ida Steffensen6, Celeste Porsbjerg2. 1. Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 66, 2400, Copenhagen, NV, Denmark. Electronic address: annavonbulow@gmail.com. 2. Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg University Hospital, Bispebjerg Bakke 66, 2400, Copenhagen, NV, Denmark. 3. Department of Respiratory and Internal Medicine, Naestved Hospital, Denmark; Institute for Regional Health Research, University of Southern Denmark, Denmark; Department of Respiratory and Internal Medicine, Roskilde Hospital, Denmark. 4. Department of Respiratory and Internal Medicine, Roskilde Hospital, Denmark. 5. Department of Respiratory and Infection Medicine, Hilleroed Hospital, Denmark. 6. Department of Respiratory and Infection Medicine, Hilleroed Hospital, Denmark; Respiratory Division, Internal Medicine O, HGH University Hospital Herlev, Denmark.
Abstract
BACKGROUND: Guidelines recommend a differentiation of difficult-to-treat asthma from severe asthma. However, this might be complex and to which extent this distinction is achievable in clinical practice remains unknown. OBJECTIVE: To evaluate to which degree a systematic evaluation protocol enables a differentiation between severe versus difficult-to-treat asthma in patients in specialist care on high intensity asthma treatment, i.e. potentially severe asthma. METHODS: All adult asthma patients seen in four respiratory clinics over one year were screened prospectively for asthma severity. Patients with difficult-to-control asthma according to ERS/ATS criteria (high-dose inhaled corticosteroids/oral corticosteroids) underwent systematic assessment to differentiate severe asthma patients from those with other causes of poor asthma control: objective confirmation of the asthma diagnosis as well as assessment of treatment barriers and comorbidities. RESULTS: Overall, 1034 asthma patients were screened, of whom 175 (16.9%) had difficult-to-control asthma. 117 of these accepted inclusion, and completed systematic assessment. Asthma diagnosis was objectively confirmed in 88%. Sub-optimal adherence (42.5%), inhaler errors (31.5%) and unmanaged comorbidities (66.7%) were common. After primary assessment, 12% (14/117) fulfilled strict criteria for severe asthma. Moreover, 56% (66/117) were instantly classified as difficult-to-treat asthma due to poor adherence/inhaler technique. Finally, an ´overlap' group of 32% (37/117) were identified with patients being adherent and displaying correct inhaler technique, but had unmanaged comorbidities -potentially fitting into both the difficult-to-treat and severe group. CONCLUSION: Only a minority of patients with difficult-to-control asthma were found to have severe asthma after primary systematic assessment. Nevertheless, strict categorisation of severe vs. difficult-to-treat asthma seems to pose a challenge.
BACKGROUND: Guidelines recommend a differentiation of difficult-to-treat asthma from severe asthma. However, this might be complex and to which extent this distinction is achievable in clinical practice remains unknown. OBJECTIVE: To evaluate to which degree a systematic evaluation protocol enables a differentiation between severe versus difficult-to-treat asthma in patients in specialist care on high intensity asthma treatment, i.e. potentially severe asthma. METHODS: All adult asthmapatients seen in four respiratory clinics over one year were screened prospectively for asthma severity. Patients with difficult-to-control asthma according to ERS/ATS criteria (high-dose inhaled corticosteroids/oral corticosteroids) underwent systematic assessment to differentiate severe asthmapatients from those with other causes of poor asthma control: objective confirmation of the asthma diagnosis as well as assessment of treatment barriers and comorbidities. RESULTS: Overall, 1034 asthmapatients were screened, of whom 175 (16.9%) had difficult-to-control asthma. 117 of these accepted inclusion, and completed systematic assessment. Asthma diagnosis was objectively confirmed in 88%. Sub-optimal adherence (42.5%), inhaler errors (31.5%) and unmanaged comorbidities (66.7%) were common. After primary assessment, 12% (14/117) fulfilled strict criteria for severe asthma. Moreover, 56% (66/117) were instantly classified as difficult-to-treat asthma due to poor adherence/inhaler technique. Finally, an ´overlap' group of 32% (37/117) were identified with patients being adherent and displaying correct inhaler technique, but had unmanaged comorbidities -potentially fitting into both the difficult-to-treat and severe group. CONCLUSION: Only a minority of patients with difficult-to-control asthma were found to have severe asthma after primary systematic assessment. Nevertheless, strict categorisation of severe vs. difficult-to-treat asthma seems to pose a challenge.
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Authors: J Mark FitzGerald; Trung N Tran; Marianna Alacqua; Alan Altraja; Vibeke Backer; Leif Bjermer; Unnur Bjornsdottir; Arnaud Bourdin; Guy Brusselle; Lakmini Bulathsinhala; John Busby; Giorgio W Canonica; Victoria Carter; Isha Chaudhry; You Sook Cho; George Christoff; Borja G Cosio; Richard W Costello; Neva Eleangovan; Peter G Gibson; Liam G Heaney; Enrico Heffler; Mark Hew; Naeimeh Hosseini; Takashi Iwanaga; David J Jackson; Rupert Jones; Mariko S Koh; Thao Le; Lauri Lehtimäki; Dora Ludviksdottir; Anke H Maitland-van der Zee; Andrew Menzies-Gow; Ruth B Murray; Nikolaos G Papadopoulos; Luis Perez-de-Llano; Matthew Peters; Paul E Pfeffer; Todor A Popov; Celeste M Porsbjerg; Chris A Price; Chin K Rhee; Mohsen Sadatsafavi; Yuji Tohda; Eileen Wang; Michael E Wechsler; James Zangrilli; David B Price Journal: BMC Med Res Methodol Date: 2020-08-14 Impact factor: 4.615