Differentiation of adult severe asthma from difficult-to-treat asthma: Outcomes of a systematic assessment protocol

Anna von Bülow*, Vibeke Backer, Uffe Bodtger, Niels Ulrik Søes-Petersen, Susanne Vest, Ida Steffensen, Celeste Porsbjerg

*Corresponding author for this work

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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.

Original languageEnglish
JournalRespiratory Medicine
Volume145
Pages (from-to)41-47
ISSN0954-6111
DOIs
Publication statusPublished - 2018

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Nebulizers and Vaporizers
Comorbidity
Adrenal Cortex Hormones
Guidelines

Keywords

  • Asthma
  • Asthma management
  • Difficult-to-treat asthma
  • Severe asthma
  • Systematic assessment

Cite this

von Bülow, Anna ; Backer, Vibeke ; Bodtger, Uffe ; Søes-Petersen, Niels Ulrik ; Vest, Susanne ; Steffensen, Ida ; Porsbjerg, Celeste. / Differentiation of adult severe asthma from difficult-to-treat asthma : Outcomes of a systematic assessment protocol. In: Respiratory Medicine. 2018 ; Vol. 145. pp. 41-47.
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title = "Differentiation of adult severe asthma from difficult-to-treat asthma: Outcomes of a systematic assessment protocol",
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.",
keywords = "Asthma, Asthma management, Difficult-to-treat asthma, Severe asthma, Systematic assessment",
author = "{von B{\"u}low}, Anna and Vibeke Backer and Uffe Bodtger and S{\o}es-Petersen, {Niels Ulrik} and Susanne Vest and Ida Steffensen and Celeste Porsbjerg",
year = "2018",
doi = "10.1016/j.rmed.2018.10.020",
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Differentiation of adult severe asthma from difficult-to-treat asthma : Outcomes of a systematic assessment protocol. / von Bülow, Anna; Backer, Vibeke; Bodtger, Uffe; Søes-Petersen, Niels Ulrik; Vest, Susanne; Steffensen, Ida; Porsbjerg, Celeste.

In: Respiratory Medicine, Vol. 145, 2018, p. 41-47.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Differentiation of adult severe asthma from difficult-to-treat asthma

T2 - Outcomes of a systematic assessment protocol

AU - von Bülow, Anna

AU - Backer, Vibeke

AU - Bodtger, Uffe

AU - Søes-Petersen, Niels Ulrik

AU - Vest, Susanne

AU - Steffensen, Ida

AU - Porsbjerg, Celeste

PY - 2018

Y1 - 2018

N2 - 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.

AB - 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.

KW - Asthma

KW - Asthma management

KW - Difficult-to-treat asthma

KW - Severe asthma

KW - Systematic assessment

U2 - 10.1016/j.rmed.2018.10.020

DO - 10.1016/j.rmed.2018.10.020

M3 - Journal article

C2 - 30509715

AN - SCOPUS:85055323520

VL - 145

SP - 41

EP - 47

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -