The level of diagnostic assessment in severe asthma: A nationwide real-life study

Anna von Bülow, Vibeke Backer, Uffe Bodtger, Niels Ulrik Søes-Petersen, Karin Dahl Assing, Tina Skjold, Celeste Porsbjerg

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.

AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.

METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.

RESULTS: Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.

CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

Original languageEnglish
JournalRespiratory Medicine
Volume124
Pages (from-to)21-29
ISSN0954-6111
DOIs
Publication statusPublished - 2017

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Nebulizers and Vaporizers
Ambulatory Care Facilities
Routine Diagnostic Tests
Multicenter Studies
Cross-Sectional Studies
Guidelines
Population

Keywords

  • Severe asthma
  • Multicenter Study
  • Difficult-to-treat asthma
  • outpatient care
  • Observational comparison study

Cite this

von Bülow, A., Backer, V., Bodtger, U., Søes-Petersen, N. U., Assing, K. D., Skjold, T., & Porsbjerg, C. (2017). The level of diagnostic assessment in severe asthma: A nationwide real-life study. Respiratory Medicine, 124, 21-29. https://doi.org/10.1016/j.rmed.2017.01.010
von Bülow, Anna ; Backer, Vibeke ; Bodtger, Uffe ; Søes-Petersen, Niels Ulrik ; Assing, Karin Dahl ; Skjold, Tina ; Porsbjerg, Celeste. / The level of diagnostic assessment in severe asthma : A nationwide real-life study. In: Respiratory Medicine. 2017 ; Vol. 124. pp. 21-29.
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abstract = "INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.RESULTS: Among 1563 patients with asthma, 98 (6.3{\%}) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1{\%}). In total, 83.7{\%} underwent at least one diagnostic test for asthma: reversibility test: 63.3{\%}, PEF: 52{\%} and bronchial challenge test: 21.4{\%}. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70{\%}; negative PEF measurement/reversibility test), only 23.1{\%} had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6{\%} of patients, respectively.CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.",
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von Bülow, A, Backer, V, Bodtger, U, Søes-Petersen, NU, Assing, KD, Skjold, T & Porsbjerg, C 2017, 'The level of diagnostic assessment in severe asthma: A nationwide real-life study', Respiratory Medicine, vol. 124, pp. 21-29. https://doi.org/10.1016/j.rmed.2017.01.010

The level of diagnostic assessment in severe asthma : A nationwide real-life study. / von Bülow, Anna; Backer, Vibeke; Bodtger, Uffe; Søes-Petersen, Niels Ulrik; Assing, Karin Dahl; Skjold, Tina; Porsbjerg, Celeste.

In: Respiratory Medicine, Vol. 124, 2017, p. 21-29.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - The level of diagnostic assessment in severe asthma

T2 - A nationwide real-life study

AU - von Bülow, Anna

AU - Backer, Vibeke

AU - Bodtger, Uffe

AU - Søes-Petersen, Niels Ulrik

AU - Assing, Karin Dahl

AU - Skjold, Tina

AU - Porsbjerg, Celeste

N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.RESULTS: Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

AB - INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.RESULTS: Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

KW - Severe asthma

KW - Multicenter Study

KW - Difficult-to-treat asthma

KW - outpatient care

KW - Observational comparison study

U2 - 10.1016/j.rmed.2017.01.010

DO - 10.1016/j.rmed.2017.01.010

M3 - Journal article

C2 - 28284317

VL - 124

SP - 21

EP - 29

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -