The burden associated with persistent, very poorly controlled (VPC) asthma was found to be high in individuals with severe or difficult-to-treat presentation of the disease, according to a study published in the Journal of Allergy and Clinical Immunology: In Practice.

In this multicenter, observational study (TENOR II; The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimen II), patients with severe/difficult-to-treat asthma who had participated in the TENOR I were followed up >10 years later during a single, cross-sectional visit.

Persistent VPC asthma was defined as VPC asthma present at both TENOR I and TENOR II enrollment. Lack of VPC asthma was defined as well- or not well-controlled asthma at either or both study visits.

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In both TENOR I and TENOR II studies, patients with severe or difficult-to-treat asthma were evaluated during a single visit. A total of 341 patients were enrolled in TENOR II, with the single follow-up visit taking place between December 2013 and December 2014. Of the 327 patients with available data on the level of asthma control in both studies, 48.0% and 52.0% were classified as having and not having persistent VPC asthma, respectively.

Patients with vs without persistent VPC asthma were found to be more likely to be older (59.7 years vs 55.9 years, respectively), obese (50.3% vs 42.4%, respectively), of black race/ethnicity (17.2% vs 5.3%, respectively), a prior smoker (31.2% vs 17.1%, respectively), and to have been previously intubated (18.2% vs 7.6%, respectively). In TENOR II, most patients were managed by an allergist/immunologist.

The total geometric mean immunoglobulin E (IgE) level were 89.3 IU/mL (95% CI, 68.9 to 115.8) and 55.7 IU/mL (95% CI, 38.8 to 80.0) in patients with and without persistent VPC asthma, respectively.

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Patients with vs without persistent VPC asthma were more likely to have comorbidities, with gastroesophageal reflux disease (52.2% vs 41.2%, respectively), high blood pressure (46.5% vs 38.2%, respectively), upper respiratory infection (35.0% vs 27.6%, respectively), food allergy (35.7% vs 27.6%, respectively,; and insomnia (31.2% vs 19.4%, respectively) most commonly observed.

Lung function was lower in patients with vs without persistent VPC asthma (mean % predicted prebrochodilator forced expiratory volume in 1 second [FEV1], 63.% vs 82.8%, respectively; mean % predicted postbronchodilator FEV1: 69.6% vs 87.2%, respectively). Disease exacerbations in the previous year were more likely to occur in individuals with vs without persistent VPC asthma (29.7% vs 9.0%, respectively).  

”Strategies to improve access and adherence to medications are paramount and highlight the need for increased implementation of step-up therapy after improved medication adherence is determined,” noted the study authors.


Haselkorn T, Szefler SJ, Chipps BE, et al. Disease burden and long-term risk of persistent very poorly controlled asthma: TENOR II [published online March 12, 2020]. J Allergy Clin Immunol Pract. pii: S2213-2198(20)30241-5. doi: 10.1016/j.jaip.2020.02.040