CHRONICLE Trial Identifies Exacerbation Triggers of Severe Asthma

Asian woman using a pressurized cartridge inhaler extended pharynx, Bronchodilator
CHRONICLE investigators reported results of a patient survey on common asthma triggers at ACAAI 2021.

The following article is a part of conference coverage from the American College of Allergy, Asthma & Immunology 2021 Annual Scientific Meeting, being held virtually from November 4 to 8, 2021. The team at Pulmonology Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the ACAAI 2021 Annual Scientific Meeting.


Exacerbation triggers are an important part of understanding the impact of severe asthma on health-related quality of life (HRQoL), according to authors of a study presented at the 2021 American College of Allergy, Asthma and Immunology (ACAAI) Annual Scientific Meeting, held in New Orleans, LA, from November 4 to 8.

Patient-reported disease triggers and their associated disease burden have not been well described in patients with severe asthma. As part of the observational CHRONICLE study ( Identifier: NCT03373045), researchers evaluated subspecialist-treated patients with severe asthma who received biologics or maintenance systemic corticosteroids, comparing them with patients with uncontrolled asthma who received high-dosage inhaled corticosteroids with additional controllers.

Patients in the study completed a survey about common triggers of asthma symptoms and/or attacks using prespecified categories as well as the St. George’s Respiratory Questionnaire (SGRQ) for HRQoL.

Among 2793 enrolled patients, 1434 completed the triggers questionnaire; the median SGRQ score was 42 (n=1166). Patients reported 8 trigger categories on average, with the most prevalent being weather changes (78%), viral infections (70%), seasonal allergies (67%), and year-round allergies (67%). For patients who reported worse HRQoL (median SGRQ score higher than 50), the most common triggers were cleaning/housework (35%) and strong emotions (34%).

Patients who reported cleaning/housework or strong emotions as triggers were more likely to be female, have comorbidities (such as sleep apnea, gastroesophageal reflux disease, hypertension, depression, and anxiety), have uncontrolled asthma, report reduced work productivity, and be disabled.

“In this real-world cohort of subspecialist-treated adults with [severe asthma], the most prevalent exacerbation triggers were weather, viral infections, and allergies,” the investigators concluded. They added, “Asthma-related HRQoL was worse with cleaning/housework and strong emotions as triggers. Triggers are an important part of understanding the impact of patients’ asthma on HRQoL.”


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Chipps B, Soong W, Panettieri R, et al. Disease triggers and associated quality of life among specialist-treated US patients with severe asthma. Presented at: American College of Allergy, Asthma & Immunology (ACAAI) Annual Scientific Meeting; November 4-8, 2021; New Orleans, LA. Abstract P065.