Patients with severe asthma and the subspecialists who treat them have varying perceptions of disease control and treatment effectiveness. This was among the findings of the CHRONICLE study (ClinicalTrials.gov identifier: NCT03373045) that were recently published in the Journal of Asthma.
CHRONICLE, a large, ongoing, observational study of patients with severe asthma and their treating subspecialists (US allergists or pulmonologists), evaluated concurrent patient and specialist assessments of asthma control and treatment effectiveness. Investigators evaluated asthma control using patient-completed Asthma Control Tests (ACT) and specialist clinical assessments of asthma control. Treatment effectiveness was gauged using the Global Evaluation of Treatment Effectiveness (GETE), which was completed by both specialists and patients at study enrollment.
A total of 1884 adult patients were enrolled in the study, with 59% (1109) completing at least 1 online survey at enrollment. Of these participants, 67% were being treated with biologic agents, 13% were receiving maintenance systemic corticosteroids (mSCS), and 27% were receiving high-dosage inhaled corticosteroids with additional controllers (HD ICS+) only with biologics or mSCS (with 7% receiving both biologic agents and mSCS).
Based on patient-reported ACT scores from 1038 participants at study enrollment, investigators classified 67% of the participants as having uncontrolled asthma, with 25% of those cases deemed as not well controlled and 42% deemed as very poorly controlled. The prevalence of uncontrolled asthma, as indicated by ACT scores, was higher among those treated with mSCS (91%) and HD ICS+ only (84%) compared with patients receiving biologic therapy (58%).
In contrast, clinical assessments completed by 1022 specialists indicated that 44% of participants had uncontrolled asthma. The specialists’ assessments also indicated a higher prevalence of asthma among individuals treated with HD ICS+ only (63%) and mSCS (62%) compared with those receiving biologic therapy (33%).
In GETE responses, specialists reported some improvement for 71% of their patients and no improvement or worsening of asthma for 29% of patients. In comparison, 90% of patients reported some improvement of their asthma, and 10% reported no improvement or worsening of asthma in their GETE responses. Categorizations of specialist and patient treatment effectiveness were in agreement for 73%.
Overall, “Specialists commonly overestimated asthma control” relative to patient-reported ACT scores, and patients “reported treatment effectiveness more frequently than specialists,” said investigators. Findings from this study highlight the importance of using validated instruments to evaluate asthma control and thus reduce potential treatment gaps associated with patient-specialist discordance, researchers noted.
Disclosure: Some of the study authors have declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.
Panettieri RA Jr, Chipps BE, Moore WC, et al. Differing perceptions of asthma control and treatment effectiveness by patients with severe asthma and treating subspecialists in the United States. J Asthma. Published online August 10, 2021. doi:10.1080/02770903.2021.1963766