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.

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.


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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.

Reference

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