Health Care Situation in the Treatment of Uncontrolled GINA Step 4/5 Patients in Germany.

It has been estimated that, in 2019, 54,000 patients in Germany had uncontrolled GINA step 4/5 asthma. In the current study we analyzed which health care providers were involved in the management of these patients and their role in disease phenotyping. The year 2019 was retrospectively analyzed using the IQVIA Of 54,000 uncontrolled GINA step 4/5 asthma patients in Germany, 52% had consulted both general practitioners (GPs) and pulmonologists, and 48% were seen exclusively by a GP. Of these 54,000 patients, 45% were being prescribed and were thus overusing short-acting β2-agonists (SABAs) and oral corticosteroids (OCS) for ≥2 years, 26% for ≥3 years, and 16% for ≥4 years. In most regions, pulmonologists saw one of their uncontrolled GINA step 4/5 asthma patients per week. Laboratory tests from consultations with a GP were available for only 10% of patients referred to a pulmonologist. In 50% of uncontrolled asthma patients treated according to GINA step 4/5, these were initiated by the pulmonologist, and 34% received laboratory testing within the first year (in GINA step 4/5 asthma, the numbers are 20% and 18%, respectively). Fifty percent of uncontrolled asthma patients treated according to GINA step 4/5 were regularly seen by pulmonologists, who performed most of the phenotyping confirming their importance in the management of severe, uncontrolled asthma in Germany. To understand treatment pathways for these patients, further studies are needed.

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© 2023 Timmermann et al.

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C.N. received honoraria and advisory board fees from GSK, Sanofi, AstraZeneca and Novartis. D.K. reports speaker and/or advisory fees from AstraZeneca, Boehringer, Chiesi, Berlin-Chemie, GSK, Novartis, and Sanofi. K.C.B. and O.S. have no relevant competing interests to disclose. S.H. is a GSK employee and shareholder. K.M. reports speaker and/or advisory fees from Astrazeneca, GSK, Novartis, Sanofi. D.S. received honoraria for lectures and/or consultancy from AstraZeneca, Bayer, Berlin-Chemie, BMBF, Boehringer, Chiesi, DFG, GSK, Janssen, MSD, Novartis, Sanofi, Pfizer. F.S. is affiliated with IQVIA Commercial GmbH & Co and reports grants from GSK. J.C.V. has lectured for and received honoraria from AstraZeneca, Avontec, Bayer, Bencard, Bionorica, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, Leti, MEDA, Merck, MSD, Mundipharma, Novartis, Nycomed/Altana, Pfizer, Revotar, Sandoz-Hexal, Stallergens, TEVA, UCB/Schwarz-Pharma, and Zydus/Cadila, and has participated in advisory boards for Avontec, Boehringer-Ingelheim, Chiesi, Essex/Schering-Plough, GSK, Janssen-Cilag, MEDA, MSD, Mundipharma, Novartis, Regeneron, Revotar, Roche, Sanofi-Aventis, Sandoz-Hexal, TEVA, and UCB/Schwarz-Pharma, and has received research grants from Deutsche Forschungsgesellschaft, Land Mecklenburg-Vorpommern, GSK, and MSD, and is a full-time employee of the Universitätsmedizin Rostock. The authors report no other conflicts of interest in this work.