Gaps in the care of severe asthmatics persist in U.S.
Published: March 17, 2024
An estimated 7.7% of Americans currently live with asthma, 5–10% of whom may suffer from severe asthma. Severe asthma patients contribute to the majority of the economic and humanistic burden of the disease, and the appropriate treatment of severe asthma includes specialist consultation for disease management and potential add-on asthma treatments, especially following an exacerbation or worsening of the disease. However, the real-world frequency of such escalation of care for U.S. severe asthma patients with uncontrolled disease has not been previously studied.
In a study published in The Journal of Allergy and Clinical Immunology: In Practice, Carr et al. conducted a retrospective database analysis of two nationally representative U.S. claims-based databases (the MORE2 Registry® from Inovalon, and the 100% Medicare Fee-for-Service database) to compare the medical care received by severe asthma patients who did or did not experience events indicating uncontrolled disease (EUD), including corticosteroid-requiring asthma exacerbations, asthma-related emergency room visits, or asthma-related hospitalization. Escalation of medical care including visits to a specialist and changes to asthma treatment were examined, in addition to the frequency of subsequent disease exacerbations and healthcare use/costs. The authors also investigated health disparities by examining outcomes by patients of different race/ethnicities.
A total of 180,736 severe asthma patients were identified (90,368 with uncontrolled disease, and 90,368 with controlled disease). Among the severe asthma cohort with uncontrolled disease, approximately 40% of patients did not have a specialist visit or evidence of medication escalation following an event indicative of uncontrolled disease. Further, compared to non-Hispanic White patients, uncontrolled severe asthma patients who were Black or Hispanic/Latino were less likely to have a specialist visit or escalation of their existing therapy following an EUD. Additionally, the study found that patients with an EUD had a substantially elevated risk of subsequent asthma exacerbations. The authors conclude that the results of this investigation demonstrate that a substantial proportion of uncontrolled severe asthma patients in the U.S. did not receive the appropriate care following evidence of uncontrolled disease, which was associated with worsening disease and greater healthcare utilization. The findings highlight the need for improved guideline-based delivery of care to severe asthma patients, particularly among those potentially facing social disparities.
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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