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Severe asthma systematic assessment improves outcomes and halves oral corticosteroids

Published online: January 15, 2020

Guidelines for severe and difficult asthma recommend systematic assessment as it has been shown to improve a number of asthma-related outcomes. Previous studies have shown a variable impact of systematic assessment on oral corticosteroid burden, an important outcome in severe and difficult asthma. It is unclear if systematic assessment for severe and difficult asthma has a role in the era of targeted therapies for severe asthma, particularly in reducing oral steroid burden.

In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Denton, et al evaluated patients with severe and difficult asthma undergoing systematic assessment that consisted of two intensive clinic visits over a six-month period. The focus of the structured assessment is to confirm the asthma diagnosis, formally assess medication adherence, provide asthma education and improve inhaler technique, diagnose and treat comorbid conditions, and phenotype and optimize asthma therapy including the use of biologic medications where applicable. Asthma outcomes, including asthma-related quality of life, symptoms, forced expiratory volume in one second (FEV1) and exacerbations, were measured at baseline and follow up (after 6 months).

This study showed that, even in the era of targeted therapies for severe asthma, systematic assessment improves outcomes in at least one domain for just under 90% of patients. This improvement across a number of asthma-specific domains included: 54% had significantly improved quality of life, 54% had improved symptoms, 40% had improved lung function, and 64% had reduced asthma exacerbations. These improvements occurred independent of the use of biologic medications. They also did not come at the expense of increased oral corticosteroid burden – in fact, oral corticosteroid burden was halved.

Systematic assessment for difficult and severe asthma has a clear role even in the era of targeted therapies for asthma in improving key asthma-related outcomes and reducing oral corticosteroid burden.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

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