Published online: March 12, 2020
Severe or difficult-to-treat asthma occurs in 5–10% of patients with asthma, but accounts for more than 50% of related economic costs. Understanding the factors that are associated with very poorly controlled asthma may improve treatment outcomes.
In a research article recently published in The Journal of Allergy and Clinical Immunology: In Practice, Haselkorn and colleagues used a multivariable regression model to analyze long-term predictors of persistent very poorly controlled asthma (defined using the impairment domain of the National Heart, Lung and Blood Institute (NHLBI) asthma guidelines) in patients with severe or difficult-to-treat asthma after more than 10 years of standard of care treatment (TENOR II).
Nearly half (48%) of patients studied had persistent very poorly controlled asthma. Predictors of persistent very poorly controlled asthma were black versus white race/ethnicity, having a higher sensitivity to allergens (a higher allergic trigger count), increased use of systemic corticosteroids, and reduced lung function. It was also found that comorbidities, such as gastroesophageal reflux disease, high blood pressure, upper respiratory tract infections, food allergies, and insomnia were reported more frequently in patients with persistent very poorly controlled asthma than in those without. Asthma worsenings (exacerbations) in the prior year were also more likely in patients with persistent and very poorly controlled asthma.
Despite current treatment, patients in TENOR II remain a severe disease cohort characterized by poor asthma control, a high occurrence of comorbidities, numerous allergic triggers, reduced lung function, and high exacerbation rates. Management of modifiable risk factors, improvement in lung function, and trigger avoidance may improve outcomes in severe asthma.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.