Characteristics of the European Thoracic Society/American Thoracic Society severe asthma definition as a determinant of future use of biologics/bronchial thermoplasty.

Background

International guidelines define severe uncontrolled asthma. Biologics or bronchial thermoplasty (Bio/BT) are recommended for such patients.

Objectives

To determine which definitions of severe uncontrolled asthma are associated with an additional Bio/BT treatment in patients with severe uncontrolled asthma.

Methods

Consecutive 107 asthmatics (including 15 patients for whom Bio/BT was introduced within 3 months after examination), classified as treatment step 4 according to the Global Initiative for Asthma 2015 guideline, were eligible for this analysis. Patients were assessed using the European Thoracic Society/American Thoracic Society (ERS/ATS) severe uncontrolled asthma guideline as defined by these 4 characteristics: poor control (ACT < 20), frequent exacerbations (≥2/yr), admissions (≥1/yr), and airflow limitation (forced expiratory volume in 1 second < 80% of predicted), along with comorbidities, and biomarkers, including blood granulocytes, fractional nitric oxide, and capsaicin cough reflex sensitivity (C-CS). These indices were compared between patients with and without Bio/BT introduction, and multivariate logistic regression analysis was performed to determine the association of the 4 definitions with treatment needs for Bio/BT.

Results

Patients who were introduced to Bio/BT had heightened C-CS, heavier smoking history, and a greater prevalence of diabetes mellitus than those without (

Conclusion

Although multiple factors such as treatment cost and asthma phenotypes affect treatment decision-making, the definition of poor asthma control, frequent exacerbations and admission by the ERS/ATS guidelines were important factors for an additional intensive treatment for severe uncontrolled asthma.

Trial Registration

UMIN Clinical Trials Registry: UMIN000024734.

Informations de copyright

Copyright © 2022. Asia Pacific Association of Allergy, Asthma and Clinical Immunology.

Déclaration de conflit d'intérêts

Conflict of Interest: Y.K. reports research grants from Novartis Pharma, MSD, Sanofi, and Kyowa-Kirin corporations outside the submitted manuscript. K.F. reports research grants from Novartis Pharma and GSK outside the submitted manuscript. S.F. reports personal fees from AstraZeneca and Eli Lilly Japan outside the submitted work. H.O. reports a research grant from Boehringer Ingelheim outside of the submitted work. K.M. reports personal fees from Pfizer and Chugai Pharmaceutical outside of the submitted work. T. O. reports personal fees from AstraZeneca, Eli Lilly Japan, Taiho Pharmaceutical, Pfizer, Chugai Pharmaceutical, MSD, Daiichi Sankyo, and Asahi Kasei Pharma, as well as research grants and personal fees from Kyowa Hakko Kirin, Boehringer Ingelheim, Ono Pharmaceutical, and Novartis outside the submitted work. M. T. reports a research grant from Pfizer outside of the submitted work. A.N. reports personal fees from Astellas, AstraZeneca, Kyorin, GSK, Sanofi, and Boehringer Ingelheim, and research grants from Astellas, Kyorin, Sanofi, Boehringer Ingelheim, Novartis, MSD, Daiichi Sankyo, Taiho, Teijin, Ono, and Takeda Pharmaceutical outside the submitted work. H.N, N.T., R.K., T.T., J.Y., K.I., T.U., and Y.I. did not receive any grants or personal fees.