Severe asthma – There is room for improvement!

Published Online: July 25, 2014

Severe asthma is defined as asthma that requires high intensity treatment to maintain adequate disease control, or where control is not achieved despite high-level therapy. The prevalence of severe asthma is uncertain. However, experts estimate that “severe asthma” applies to 5-10 % of the entire asthmatic population. Severe asthma is believed to represent the largest burden of morbidity due to asthma. Consequently, management of severe asthma by specialists is recommended, though it is not clear to what extent this recommendation has been followed.

In an article recently published in The Journal of Allergy and Clinical Immunology: In Practice, von Bülow et al. explored the prevalence of severe asthma, the extent of asthma control and the level of specialist care among a nationwide asthma population.

The authors used a nationwide prescription database to identify asthma cases among adults aged 18-44 years in Denmark, based on regular prescriptions of anti-asthmatic therapy. Severity was classified as severe vs. mild/moderate asthma according to the average daily dosage of inhaled corticosteroids. Prescription drug use, hospitalizations, emergency department visits and outpatient clinic visits were explored according to the level of asthma severity.

Among their population, 61,583 current asthmatics were identified. Based on the level of treatment, 8.1 % was categorized as having severe asthma, 36.4% of whom had low asthma control, defined by excessive use of short-acting-beta-2-agonists, a redeemed prescription of oral prednisolone, Emergency Department visits and/or hospitalization. Notably, low asthma control was also frequent (25.2%) among subjects with mild-moderate asthma. Only approximately 35% of severe asthmatics with low asthma control had contact with asthma specialists.

Based on the level of treatment, 8.1 % of a nationwide population of current asthmatics were classified as having severe asthma. Low asthma control was more frequent among subjects with severe asthma, and only a minority were managed in specialist care. This indicates a substantial lack of awareness of asthma severity and level of asthma control, and suggests a need for more attention focused on this patient group.

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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