The majority of patients with severe and difficult-to-treat asthma who underwent systematic assessment improved significantly in at least one key asthma outcome, but with few reliable predicators of response, according to the results of an uncontrolled, observational study published in the Journal of Allergy and Clinical Immunology: In Practice.

In fact, about one-third of patients who require maintenance oral corticosteroids may be able to discontinue steroid use completely after systematic evaluation.

Investigators sought to examine which patients with asthma would respond to systematic assessment and whether the oral corticosteroid burden can be reduced independent of the use of monoclonal biologic agents. They undertook a responder analysis for improvements in the following 4 domains: symptom control, quality of life, disease exacerbations, and airflow obstruction, all of which were evaluated 6 months after the initial assessment. To identify predictors of response, multivariate analyses were conducted for each of these domains. Changes in oral corticosteroid burden were measured as well, stratified by monoclonal biologic use initiated during the assessment.


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Of 161 patients who were assessed systematically, 64% exhibited a reduction in disease exacerbations, 54% attained minimum clinically important differences regarding both symptom control and quality of life, and 40% increased their forced expiratory volume in 1 second by ≥100 mL. Overall, 87% of the participants with asthma demonstrated improvement in at least one of the domains.

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The most consistent predictor of response across all of the domains was poorer baseline asthma status. A significant decrease in mean chronic oral corticosteroid dose was observed (from 11 mg to 5 mg; n=46; P <.001), even after the exclusion of 7 individuals who initiated monoclonal biologic therapy (from 11 mg to 5.6 mg; n=39; P <.001).

The study results may have been limited by the lack of follow-up duration, as the researchers did not assess response beyond 6 months.

The investigators concluded that the use of systematic assessment in patients with severe or difficult-to-treat asthma is beneficial for most of these individuals. However, “[n]o single outcome was sufficient to assess patient response to interventions, and a combination of measures remains necessary in this area,” the researchers added.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Denton E, Lee J, Tay TR, et al. Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use [published online January 15, 2020]. J Allergy Clin Immunol Pract. doi:10.1016/j.jaip.2019.12.037