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Perez-de-Llano L, Scelo G, Canonica GW, Chen W, Henley W, Larenas-Linnemann D, Peters MJ, Pfeffer PE, Tran TN, Ulrik CS, Popov TA, Sadatsafavi M, Hew M, Máspero J, Gibson PG, Christoff GC, Fitzgerald JM, Torres-Duque CA, Porsbjerg CM, Papadopoulos NG, Papaioannou AI, Heffler E, Iwanaga T, Al-Ahmad M, Kuna P, Fonseca JA, Al-Lehebi R, Rhee CK, Koh MS, Cosio BG, Perng Steve DW, Mahboub B, Menzies-Gow AN, Jackson DJ, Busby J, Heaney LG, Patel PH, Wang E, Wechsler ME, Altraja A, Lehtimäki L, Bourdin A, Bjermer L, Bulathsinhala L, Carter V, Murray R, Beastall A, Denton E, Price DB. Impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in patients with severe asthma. Ann Allergy Asthma Immunol 2024; 132:610-622.e7. [PMID: 38151100 DOI: 10.1016/j.anai.2023.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 12/29/2023]
Abstract
BACKGROUND There is little agreement on clinically useful criteria for identifying real-world responders to biologic treatments for asthma. OBJECTIVE To investigate the impact of pre-biologic impairment on meeting domain-specific biologic responder definitions in adults with severe asthma. METHODS This was a longitudinal, cohort study across 22 countries participating in the International Severe Asthma Registry (https://isaregistries.org/) between May 2017 and January 2023. Change in 4 asthma domains (exacerbation rate, asthma control, long-term oral corticosteroid [LTOCS] dose, and lung function) was assessed from biologic initiation to 1 year post-treatment (minimum 24 weeks). Pre- to post-biologic changes for responders and nonresponders were described along a categorical gradient for each domain derived from pre-biologic distributions (exacerbation rate: 0 to 6+/y; asthma control: well controlled to uncontrolled; LTOCS: 0 to >30 mg/d; percent-predicted forced expiratory volume in 1 second [ppFEV1]: <50% to ≥80%). RESULTS Percentage of biologic responders (ie, those with a category improvement pre- to post-biologic) varied by domain and increased with greater pre-biologic impairment, increasing from 70.2% to 90.0% for exacerbation rate, 46.3% to 52.3% for asthma control, 31.1% to 58.5% for LTOCS daily dose, and 35.8% to 50.6% for ppFEV1. The proportion of patients having improvement post-biologic tended to be greater for anti-IL-5/5R compared with for anti-IgE for exacerbation, asthma control, and ppFEV1 domains, irrespective of pre-biologic impairment. CONCLUSION Our results provide realistic outcome-specific post-biologic expectations for both physicians and patients, will be foundational to inform future work on a multidimensional approach to define and assess biologic responders and response, and may enhance appropriate patient selection for biologic therapies. TRIAL REGISTRATION The ISAR database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization studies (ENCEPP/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EUPAS38288) and with all applicable local and international laws and regulation, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=38289). Governance was provided by ADEPT (registration number: ADEPT1220).
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Affiliation(s)
- Luis Perez-de-Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | - Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - William Henley
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Health Statistics Group, Institute of Health Research, University of Exeter Medical School, Exeter, United Kingdom
| | | | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia; Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital - Hvidovre, Hvidovre, Denmark
| | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Jorge Máspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina; University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Argentina
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | | | - J Mark Fitzgerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Celeste M Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Lung Division, Royal Brompton & Harefield Hospitals, London, United Kingdom
| | - David J Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, Northern Ireland, United Kingdom
| | - Pujan H Patel
- Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom
| | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Aaron Beastall
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Eve Denton
- Allergy, Asthma & Clinical Immunology, Alfred Health, Melbourne, Australia; Department of Medicine, Central Clinical School, Monash University, Melbourne, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.
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Scelo G, Torres-Duque CA, Maspero J, Tran TN, Murray R, Martin N, Menzies-Gow AN, Hew M, Peters MJ, Gibson PG, Christoff GC, Popov TA, Côté A, Bergeron C, Dorscheid D, FitzGerald JM, Chapman KR, Boulet LP, Bhutani M, Sadatsafavi M, Jiménez-Maldonado L, Duran-Silva M, Rodriguez B, Celis-Preciado CA, Cano-Rosales DJ, Solarte I, Fernandez-Sanchez MJ, Parada-Tovar P, von Bülow A, Bjerrum AS, Ulrik CS, Assing KD, Rasmussen LM, Hansen S, Altraja A, Bourdin A, Taille C, Charriot J, Roche N, Papaioannou AI, Kostikas K, Papadopoulos NG, Salvi S, Long D, Mitchell PD, Costello R, Sirena C, Cardini C, Heffler E, Puggioni F, Canonica GW, Guida G, Iwanaga T, Al-Ahmad M, Linnemann DL, Garcia U, Kuna P, Fonseca JA, Al-Lehebi R, Koh MS, Rhee CK, Cosio BG, de Llano LP, Perng Steve DW, Huang EWC, Wang HC, Tsai MJ, Mahboub B, Salameh LIJ, Jackson D, Busby J, Heaney LG, Pfeffer P, Goddard AG, Wang E, Hoyte F, Wechsler ME, Chapman N, Katial R, Carter V, Bulathsinhala L, Eleangovan N, Ariti C, Lyu J, Price DB, Porsbjerg C. Analysis of comorbidities and multimorbidity in adult patients in the International Severe Asthma Registry. Ann Allergy Asthma Immunol 2024; 132:42-53. [PMID: 37640263 DOI: 10.1016/j.anai.2023.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 08/06/2023] [Accepted: 08/12/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Investigation for the presence of asthma comorbidities is recommended by the Global Initiative for Asthma because their presence can complicate asthma management. OBJECTIVE To understand the prevalence and pattern of comorbidities and multimorbidity in adults with severe asthma and their association with asthma-related outcomes. METHODS This was a cross-sectional study using data from the International Severe Asthma Registry from 22 countries. A total of 30 comorbidities were identified and categorized a priori as any of the following: (1) potentially type 2-related comorbidities, (2) potentially oral corticosteroid (OCS)-related comorbidities, or (3) comorbidities mimicking or aggravating asthma. The association between comorbidities and asthma-related outcomes was investigated using multivariable models adjusted for country, age at enrollment, and sex (ie male or female). RESULTS Of the 11,821 patients, 69%, 67%, and 55% had at least 1 potentially type 2-related, potentially OCS-related, or mimicking or aggravating comorbidities, respectively; 57% had 3 or more comorbidities, and 33% had comorbidities in all 3 categories. Patients with allergic rhinitis, nasal polyposis, and chronic rhinosinusitis experienced 1.12 (P = .003), 1.16 (P < .001), and 1.29 times (P < .001) more exacerbations per year, respectively, than those without. Patients with nasal polyposis and chronic rhinosinusitis were 40% and 46% more likely (P < .001), respectively, to have received long-term (LT) OCS. All assessed potential OCS-related comorbidities (except obesity) were associated with a greater likelihood of LTOCS use (odds ratios [ORs]: 1.23-2.77) and, except for dyslipidemia, with a greater likelihood of uncontrolled asthma (ORs: 1.29-1.68). All mimicking or aggravating comorbidities assessed were associated with more exacerbations (1.24-1.68 times more), all (except bronchiectasis) with increased likelihood of uncontrolled asthma (ORs: 1.57-1.81), and all (except chronic obstructive pulmonary disease) with increased likelihood of LTOCS use (ORs: 1.37-1.57). A greater number of comorbidities was associated with worse outcomes. CONCLUSION In a global study, comorbidity or multimorbidity is reported in most adults with severe asthma and is associated with poorer asthma-related outcomes. CLINICAL TRIAL REGISTRATION The International Severe Asthma Registry database has ethical approval from the Anonymous Data Ethics Protocols and Transparency (ADEPT) committee (ADEPT0218) and is registered with the European Union Electronic Register of Post-Authorization Studies (European Network Centres for Pharmacoepidemiology and Pharmacovigilance [ENCEPP]/DSPP/23720). The study was designed, implemented, and reported in compliance with the European Network Centres for Pharmacoepidemiology and Pharmacovigilance (ENCEPP) Code of Conduct (EMA 2014; EUPAS44024) and with all applicable local and international laws and regulations, and registered with ENCEPP (https://www.encepp.eu/encepp/viewResource.htm?id=48848). Governance was provided by ADEPT (registration number: ADEPT1121).
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Affiliation(s)
- Ghislaine Scelo
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia; Universidad de La Sabana, Chia, Colombia
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland
| | - Ruth Murray
- Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neil Martin
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland; University of Leicester, Leicester, United Kingdom
| | - Andrew N Menzies-Gow
- AstraZeneca, Cambridge, United Kingdom; Royal Brompton and Harefield Hospitals, London, United Kingdom
| | - Mark Hew
- Allergy, Asthma, and Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, Australia
| | | | - Todor A Popov
- University Hospital Sv. Ivan Rilski, Sofia, Bulgaria
| | - Andréanne Côté
- Department of Medicine, Laval University, Quebec, Canada
| | - Celine Bergeron
- Vancouver General Hospital and University of British Columbia, Vancouver, Canada
| | - Delbert Dorscheid
- Center for Heart Lung Innovation, University of British Columbia, Vancouver, Canada
| | - J Mark FitzGerald
- Department of Medicine, The University of British Columbia, Vancouver, Canada
| | | | | | - Mohit Bhutani
- Division of Pulmonary Medicine, Department of Medicine, University of Alberta, Alberta, Canada
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Libardo Jiménez-Maldonado
- Universidad de La Sabana, Chia, Colombia; Fundación Neumológica Colombiana, ASMAIRE Program, Bogotá, Colombia
| | | | | | - Carlos Andres Celis-Preciado
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | | | - Ivan Solarte
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Maria Jose Fernandez-Sanchez
- Pulmonary Unit, Hospital Universitario San Ignacio, Bogota, Colombia; Faculty of Medicine, Pontificia Universidad Javeriana, Hospital Universitario San Ignacio, Bogota, Colombia
| | - Patricia Parada-Tovar
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Anna von Bülow
- Respiratory Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg hospital, Copenhagen, Denmark
| | - Anne Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Denmark
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital, Hvidovre, Denmark
| | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Susanne Hansen
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark; Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Camille Taille
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université Paris Cité, Paris, France
| | - Jeremy Charriot
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Nicolas Roche
- Department of Respiratory Medicine, APHP-Centre University Paris Cité, Cochin Hospital and Institute (UMR1016), Paris, France
| | - Andriana I Papaioannou
- Second Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Nikolaos G Papadopoulos
- Division of Infection, Immunity, and Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, Second Pediatric Clinic, University of Athens, Athens, Greece
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Deirdre Long
- Department of Medicine, Beaumont Hospital, Dublin, Ireland
| | | | - Richard Costello
- Clinical Research Centre, Department of Respiratory Medicine, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | | | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Giuseppe Guida
- Severe Asthma and Rare Lung Disease Unit, Department of Clinical and Biological Sciences, San Luigi Gonzaga University Hospital, University of Turin, Orbassano, Turin, Italy
| | | | - Mona Al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait City, Kuwait; Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | | | - Ulises Garcia
- Department of Allergy and Immunology, National Medical Center of Bajio, Professor of Allergy and Immunology in the University of Guanajuato, Guanajuato, Mexico
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - João A Fonseca
- CINTESIS@RISE, MEDCIDS, Faculty of Medicine of the University of Porto, Porto, Portugal
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia; Alfaisal University, Riyadh, Saudi Arabia
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore
| | - Chin Kook Rhee
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, St. Mary's Hospital, Seoul, South Korea; College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Luis Perez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Monforte, Cervo, Spain
| | - Diahn-Warng Perng Steve
- School of Medicine, National Yang Ming Chiao Tung University, Hsinchu, Taiwan; Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Erick Wan-Chun Huang
- Division of Pulmonary Medicine, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
| | - Hao-Chien Wang
- Department of Medicine, National Taiwan University Cancer Center, Taipei, Taiwan
| | - Ming-Ju Tsai
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan; Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - Laila Ibraheem Jaber Salameh
- Rashid hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates; College of Medicine, University of Sharjah, Sharjah, United Arab Emirates
| | - David Jackson
- Guy's Severe Asthma Centre, Guy's Hospital, King's College London, London, United Kingdom
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom
| | - Liam G Heaney
- Wellcome-Wolfson Institute for Experimental Medicine, Queen's University Belfast, Belfast, United Kingdom
| | - Paul Pfeffer
- Department of Respiratory Medicine, Barts Health National Health Service (NHS) Trust, London, United Kingdom; Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, United Kingdom
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Flavia Hoyte
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Nicholas Chapman
- Saint Joseph Hospital, Denver Colorado National Jewish Health, Denver, Colorado
| | - Rohit Katial
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health, Denver, Colorado
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Con Ariti
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom
| | - Juntao Lyu
- Centre for Applied Health Economics, Griffith University, Brisbane, Australia
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care Global, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
| | - Celeste Porsbjerg
- Research Unit, Department of Respiratory Medicine and Infectious Diseases, Bispebjerg Hospital, Copenhagen, Denmark
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Harvey ES, Peters MJ. Asthma registries: Tedious paperwork or a versatile tool for the generation of knowledge-Insights from the Australasian Severe Asthma Registry (ASAR). Respirology 2023; 28:986-988. [PMID: 37609796 DOI: 10.1111/resp.14585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/24/2023]
Affiliation(s)
- Erin S Harvey
- Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
- School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
- Asthma and Breathing Program, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Concord, New South Wales, Australia
- Faculty of Medicine, Health and Health Sciences, Macquarie University, Sydney, New South Wales, Australia
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4
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Cushen B, Koh MS, Tran TN, Martin N, Murray R, Uthaman T, Goh CYY, Vella R, Eleangovan N, Bulathsinhala L, Maspero JF, Peters MJ, Schleich F, Pitrez P, Christoff G, Sadatsafavi M, Torres-Duque CA, Porsbjerg C, Altraja A, Lehtimäki L, Bourdin A, Taube C, Papadopoulos NG, Zsuzsanna C, Björnsdóttir U, Salvi S, Heffler E, Iwanaga T, al-Ahmad M, Larenas-Linnemann D, van Boven JFM, Aarli BB, Kuna P, Loureiro CC, Al-lehebi R, Lee JH, Marina N, Bjermer L, Sheu CC, Mahboub B, Busby J, Menzies-Gow A, Wang E, Price DB. Adult Severe Asthma Registries: A Global and Growing Inventory. Pragmat Obs Res 2023; 14:127-147. [PMID: 37881411 PMCID: PMC10595155 DOI: 10.2147/por.s399879] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 09/11/2023] [Indexed: 10/27/2023] Open
Abstract
Aim The International Severe Asthma Registry (ISAR; http://isaregistries.org/) uses standardised variables to enable multi-country and adequately powered research in severe asthma. This study aims to look at the data countries within ISAR and non-ISAR countries reported collecting that enable global research that support individual country interests. Methods Registries were identified by online searches and approaching severe asthma experts. Participating registries provided data collection specifications or confirmed variables collected. Core variables (results from ISAR's Delphi study), steroid-related comorbidity variables, biologic safety variables (serious infection, anaphylaxis, and cancer), COVID-19 variables and additional variables (not belonging to the aforementioned categories) that registries reported collecting were summarised. Results Of the 37 registries identified, 26 were ISAR affiliates and 11 non-ISAR affiliates. Twenty-five ISAR-registries and 4 non-ISAR registries reported collecting >90% of the 65 core variables. Twenty-three registries reported collecting all optional steroid-related comorbidity variables. Twenty-nine registries reported collecting all optional safety variables. Ten registries reported collecting COVID-19 variables. Twenty-four registries reported collecting additional variables including data from asthma questionnaires (10 Asthma Control Questionnaire, 20 Asthma Control Test, 11 Asthma Quality of Life Questionnaire, and 4 EuroQol 5-dimension 5-level Questionnaire). Eight registries are linked to databases such as electronic medical records and national claims or disease databases. Conclusion Standardised data collection has enabled individual severe asthma registries to collect unified data and increase statistical power for severe asthma research irrespective of ISAR affiliations.
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Affiliation(s)
- Breda Cushen
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | | | - Neil Martin
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
| | | | - Thendral Uthaman
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Celine Yun Yi Goh
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Rebecca Vella
- Optimum Patient Care, Brisbane, Queensland, Australia
| | - Neva Eleangovan
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Lakmini Bulathsinhala
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
| | - Jorge F Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | - Matthew J Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Florence Schleich
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
| | - Paulo Pitrez
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
| | | | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
| | - Celeste Porsbjerg
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Csoma Zsuzsanna
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
| | - Unnur Björnsdóttir
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Mona al-Ahmad
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | | | - Job F M van Boven
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
| | - Bernt Bøgvald Aarli
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Piotr Kuna
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
| | - Cláudia Chaves Loureiro
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
| | - Riyad Al-lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
| | - Jae Ha Lee
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
| | - Nuria Marina
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Chau-Chyun Sheu
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
| | - Bassam Mahboub
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
| | - John Busby
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
| | | | - Eileen Wang
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
| | - On behalf of ISAR Inventory Study Group
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
- AstraZeneca, Gaithersburg, MD, USA
- Department of Respiratory Medicine, University of Leicester, Leicester, UK
- Optimum Patient Care Global, Cambridge, UK
- Observational Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Brisbane, Queensland, Australia
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina
- University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
- CHU Sart-Tilman, GIGA I3, University of Liege, Liège, Wallonia, Belgium
- Pulmonology Division, Hospital Santa Casa de Porto Alegre, Porto Alegre, Brazil
- Faculty of Public Health, Medical University, Sofia, Bulgaria
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, The University of British Columbia, Vancouver, Canada
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
- Universidad de La Sabana, Chia, Colombia
- Department of Respiratory Medicine and Infectious Diseases, Research Unit, Bispebjerg Hospital, Copenhagen, Denmark
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
- Allergy Centre, Tampere University Hospital, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK
- Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
- Asthma Outpatient Clinic, National Koranyi Institute for Pulmonology, Budapest, Hungary
- Department of Allergy and Respiratory Medicine, University Hospital, Reykjavik, Iceland
- Pulmocare Research and Education Foundation, Pune, India
- Personalized Medicine, Asthma and Allergy, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
- Kindai University Hospital, Osakasayama, Japan
- Microbiology Department, College of Medicine, Kuwait University, Kuwait, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
- Centro de Excelencia en Asma y Alergia, Hospital Médica Sur, Ciudad de México, Mexico
- University of Groningen, University Medical Center Groningen, Groningen Research Institute for Asthma and COPD (GRIAC), Department of Clinical Pharmacy & Pharmacology, Groningen, the Netherlands
- Department of Thoracic Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
- Division of Internal Medicine Asthma and Allergy, Medical University of Lodz, Lodz, Poland
- Pneumology Unit, Hospitais da Universidade de Coimbra, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
- Centre of Pneumology, Faculty of Medicine, University of Coimbra, Coimbra, Portugal
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia, Alfaisal University, Riyadh, Saudi Arabia
- Division of Pulmonology and Critical Care Medicine, Department of Internal Medicine, Haeundae Paik Hospital, Inje University College of Medicine, Busan, Republic of Korea
- Pneumology Service, Biocruces, Cruces University Hospital, Barakaldo, Spain
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
- Department of Internal Medicine, School of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Rashid Hospital, Dubai Health Authority (DHA), Dubai, United Arab Emirates
- Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen’s University Belfast, Belfast, Northern Ireland, UK
- Lung Division, Royal Brompton & Harefield Hospital, London, UK
- Division of Allergy and Clinical Immunology, Department of Medicine, National Jewish Health and University of Colorado School of Medicine, Denver and Aurora, CO, USA
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, Scotland, UK
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Moloney M, Digby G, MacKinnon M, Morra A, Barber D, Queenan J, Gupta S, To T, Lougheed MD. Primary care asthma surveillance: a review of knowledge translation tools and strategies for quality improvement. Allergy Asthma Clin Immunol 2023; 19:3. [PMID: 36650578 PMCID: PMC9843861 DOI: 10.1186/s13223-022-00755-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Accepted: 12/15/2022] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Viable knowledge translation (KT) strategies are increasingly sought to improve asthma diagnosis, particularly in primary care. Despite this understanding, practical KT tools to support primary care practitioners are not widely available. Electronic medical records (EMRs) offer an opportunity to optimize the diagnosis and surveillance of chronic diseases such as asthma, and support quality improvement initiatives that increase adherence to guideline-recommended care. This review aims to describe the current state of electronic KT electronic tools (eTools) and surveillance systems for asthma and identify opportunities to increase adherence to asthma diagnostic guidelines by implementing digital KT eTools. METHODS Systematic literature searches were conducted on Ovid MEDLINE that included the search terms: asthma, asthma diagnosis, asthma surveillance, electronic health records, translational medical research, quality improvement, professional practice gaps, and primary health care published in the previous 10 years. In total, the searches returned 971 articles, 163 of which were considered relevant and read in full. An additional 28 articles were considered after reviewing the references from selected articles. 75 articles were included in this narrative review. RESULTS Established KT eTools for asthma such as electronic questionnaires, computerized clinical decision support systems (CDSS), chronic disease surveillance networks, and asthma registries have been effective in improving the quality of asthma diagnosis and care. As well, chronic disease surveillance systems, severe asthma registries, and workplace asthma surveillance systems have demonstrated success in monitoring asthma outcomes. However, lack of use and/or documentation of objective measures of lung function, challenges in identifying asthma cases in EMRs, and limitations of data sources have created barriers in the development of KT eTools. Existing digital KT eTools that overcome these data quality limitations could provide an opportunity to improve adherence to best-practice guidelines for asthma diagnosis and management. CONCLUSION Future initiatives in the development of KT eTools for asthma care should focus on strategies that assist healthcare providers in accurately diagnosing and documenting cases of asthma. A digital asthma surveillance system could support adherence to best-practice guidelines of asthma diagnosis and surveillance by prompting use of objective methods of confirmation to confirm an asthma diagnosis within the EMR.
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Affiliation(s)
- Max Moloney
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Geneviève Digby
- grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Madison MacKinnon
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - Alison Morra
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
| | - David Barber
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada ,Canadian Primary Care Sentinel Surveillance Network (Eastern Ontario Network), Kingston, ON Canada
| | - John Queenan
- grid.410356.50000 0004 1936 8331Department of Family Medicine, Queen’s University, Kingston, ON Canada
| | - Samir Gupta
- grid.415502.7Division of Respirology, Department of Medicine, St. Michael’s Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Li Ka Shing Knowledge Institute, St. Michael’s Hospital, University of Toronto, Toronto, ON Canada
| | - Teresa To
- grid.42327.300000 0004 0473 9646Child Health Evaluative Science, Research Institute, The Hospital for Sick Children, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Dalla Lana School of Public Health, University of Toronto, Toronto, ON Canada
| | - M. Diane Lougheed
- grid.511274.4Asthma Research Unit, Kingston Health Sciences Centre, Kingston, ON Canada ,grid.410356.50000 0004 1936 8331Division of Respirology, Department of Medicine, Queen’s University, Kingston, ON Canada
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6
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de Jong CCM, Ardura-Garcia C, Pedersen ESL, Mallet MC, Mueller-Suter D, Jochmann A, Singer F, Casaulta CA, Regamey N, Moeller A, Goutaki M, Kuehni CE. Standardization of Reporting Obstructive Airway Disease in Children: A National Delphi Process. J Allergy Clin Immunol Pract 2023; 11:187-194.e6. [PMID: 36108926 DOI: 10.1016/j.jaip.2022.08.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Revised: 07/17/2022] [Accepted: 08/30/2022] [Indexed: 01/11/2023]
Abstract
BACKGROUND Pediatric pulmonologists report asthma and obstructive bronchitis in medical records in a variety of ways, and there is no consensus for standardized reporting. OBJECTIVE We investigated which diagnostic labels and features pediatric pulmonologists use to describe obstructive airway disease in children and aimed to reach consensus for standardized reporting. METHODS We obtained electronic health records from 562 children participating in the Swiss Pediatric Airway Cohort from 2017 to 2018. We reviewed the diagnosis section of the letters written by pediatric pulmonologists to referring physicians and extracted the terms used to describe the diagnosis. We grouped these terms into diagnostic labels (eg, asthma) and features (eg, triggers) using qualitative thematic framework analysis. We also assessed how frequently the different terms were used. Results were fed into a modified Delphi process to reach consensus on standardized reporting. RESULTS Pediatric pulmonologists used 123 different terms to describe the diagnosis, which we grouped into 6 diagnostic labels and 17 features. Consensus from the Delphi process resulted in the following recommendations: (i) to use the diagnostic label "asthma" for children older than 5 years and "obstructive bronchitis" or "suspected asthma" for children younger than 5 years; (ii) to accompany the diagnosis with relevant features: diagnostic certainty, triggers, symptom control, risk of exacerbation, atopy, treatment adherence, and symptom perception. CONCLUSION We found great heterogeneity in the reporting of obstructive airway disease among pediatric pulmonologists. The proposed standardized reporting will simplify communication among physicians and improve quality of research based on electronic health records.
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7
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Korn S, Milger K, Skowasch D, Schulz C, Mohrlang C, Wernitz M, Paulsson T, Hennig M, Buhl R. Real-World Experience on the Use of Mepolizumab from the Severe Asthma Registry of the German Asthma Net (MepoGAN-Study). J Asthma Allergy 2023; 16:541-552. [PMID: 37197193 PMCID: PMC10184832 DOI: 10.2147/jaa.s403286] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 05/01/2023] [Indexed: 05/19/2023] Open
Abstract
Purpose The German Asthma Net (GAN) operates a Severe Asthma Registry that provides an overview of the clinical presentation and management of patients with severe asthma. Based upon data from the GAN registry, the MepoGAN study aimed to describe clinical profiles and treatment outcomes of patients who were treated with the anti-IL-5 monoclonal antibody mepolizumab (NucalaTM) in routine practice in Germany. Patients and Methods The MepoGAN study is a descriptive retrospective non-interventional cohort study. Mepolizumab patients enrolled in the GAN registry were evaluated with results being described in two different data sets: Cohort 1 (n=131) started on mepolizumab when the patients entered the registry. Results were reported after 4 months of therapy. Patients in Cohort 2 (n=220) were on treatment with mepolizumab at the time of enrollment and follow-up data were collected after a further year of treatment. Outcome measures included asthma control, lung function, disease symptoms, OCS use, and exacerbations. Results Patients enrolled in the registry who started on mepolizumab in Cohort 1 had a mean age of 55 years, were former smokers in 51% of the cases, had a mean blood eosinophil count of 500 cells/μL, and frequently had maintenance OCS use (55%). In this real-world setting, mepolizumab therapy was associated with a clinically relevant reduction in blood eosinophils (-445.7 cells/μL), OCS use (-30%), and improvement in asthma control. Fifty-five percent (vs 10% at baseline) of the patients reported controlled or partially controlled asthma 4 months after starting therapy. In patients who were already treated with mepolizumab at registry enrollment (Cohort 2), asthma control and lung function remained stable after a further year of observation. Conclusion The GAN registry data confirm the effectiveness of mepolizumab in a real-world setting. Treatment benefits are maintained over time. While the asthma of patients treated in routine practice was more severe, the results observed with mepolizumab are broadly consistent with RCTs.
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Affiliation(s)
- Stephanie Korn
- IKF Pneumologie Mainz, Mainz and Thoraxklinik Heidelberg, Heidelberg, Germany
| | - Katrin Milger
- Department of Medicine V, University Hospital, LMU Munich, Munich and Comprehensive Pneumology Center Munich (CPC-M), Member of the German Center for Lung Research (DZL), Munich, Germany
| | | | - Christian Schulz
- University Hospital Regensburg, Internal Medicine II, Pneumology, Regensburg, Germany
| | - Cordula Mohrlang
- GlaxoSmithKline GmbH & Co. KG, Munich, Germany
- Correspondence: Cordula Mohrlang, GlaxoSmithKline GmbH & Co. KG, Prinzregentenplatz 9, München, D-81675, Germany, Tel + 49 163 360 5201, Email
| | | | | | | | - Roland Buhl
- Pulmonary Department, Johannes Gutenberg University Mainz, Mainz, Germany
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8
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Chen W, Sadatsafavi M, Tran TN, Murray RB, Wong CBN, Ali N, Ariti C, Garcia Gil E, Newell A, Alacqua M, Al-Ahmad M, Altraja A, Al-Lehebi R, Bhutani M, Bjermer L, Bjerrum AS, Bourdin A, Bulathsinhala L, von Bülow A, Busby J, Canonica GW, Carter V, Christoff GC, Cosio BG, Costello RW, FitzGerald JM, Fonseca JA, Yoo KH, Heaney LG, Heffler E, Hew M, Hilberg O, Hoyte F, Iwanaga T, Jackson DJ, Jones RC, Koh MS, Kuna P, Larenas-Linnemann D, Lehmann S, Lehtimäki LA, Lyu J, Mahboub B, Maspero J, Menzies-Gow AN, Sirena C, Papadopoulos N, Papaioannou AI, Pérez de Llano L, Perng DW, Peters M, Pfeffer PE, Porsbjerg CM, Popov TA, Rhee CK, Salvi S, Taillé C, Taube C, Torres-Duque CA, Ulrik CS, Ra SW, Wang E, Wechsler ME, Price DB. Characterization of Patients in the International Severe Asthma Registry with High Steroid Exposure Who Did or Did Not Initiate Biologic Therapy. J Asthma Allergy 2022; 15:1491-1510. [PMID: 36303891 PMCID: PMC9595059 DOI: 10.2147/jaa.s377174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Accepted: 09/23/2022] [Indexed: 11/06/2022] Open
Abstract
Background Many severe asthma patients with high oral corticosteroid exposure (HOCS) often do not initiate biologics despite being eligible. This study aimed to compare the characteristics of severe asthma patients with HOCS who did and did not initiate biologics. Methods Baseline characteristics of patients with HOCS (long-term maintenance OCS therapy for at least 1 year, or ≥4 courses of steroid bursts in a year) from the International Severe Asthma Registry (ISAR; https://isaregistries.org/), who initiated or did not initiate biologics (anti-lgE, anti-IL5/5R or anti-IL4R), were described at the time of biologic initiation or registry enrolment. Statistical relationships were tested using Pearson’s chi-squared tests for categorical variables, and t-tests for continuous variables, adjusting for potential errors in multiple comparisons. Results Between January 2015 and February 2021, we identified 1412 adult patients with severe asthma from 19 countries that met our inclusion criteria of HOCS, of whom 996 (70.5%) initiated a biologic and 416 (29.5%) did not. The frequency of biologic initiation varied across geographical regions. Those who initiated a biologic were more likely to have higher blood eosinophil count (483 vs 399 cells/µL, p=0.003), serious infections (49.0% vs 13.3%, p<0.001), nasal polyps (35.2% vs 23.6%, p<0.001), airflow limitation (56.8% vs 51.8%, p=0.013), and uncontrolled asthma (80.8% vs 73.2%, p=0.004) despite greater conventional treatment adherence than those who did not start a biologic. Both groups had similar annual asthma exacerbation rates in the previous 12 months (5.7 vs 5.3, p=0.147). Conclusion Around one third of severe HOCS asthma patients did not receive biologics despite a similar high burden of asthma exacerbations as those who initiated a biologic therapy. Other disease characteristics such as eosinophilic phenotype, serious infectious events, nasal polyps, airflow limitation and lack of asthma control appear to dictate biologic use.
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Affiliation(s)
- Wenjia Chen
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Mohsen Sadatsafavi
- Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | | | | | - Chong Boon Nigel Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
| | - Nasloon Ali
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Cono Ariti
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | - Anthony Newell
- Observational and Pragmatic Research Institute, Singapore, Singapore,Optimum Patient Care, Queensland, VIC, Australia
| | | | - Mona Al-Ahmad
- Microbiology Department, Faculty of Medicine, Kuwait University, Al-Rashed Allergy Center, Ministry of Health, Kuwait City, Kuwait
| | - Alan Altraja
- Department of Pulmonology, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Riyad Al-Lehebi
- Department of Pulmonology, King Fahad Medical City, Riyadh, Saudi Arabia,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohit Bhutani
- Department of Medicine, Division of Pulmonary Medicine, University of Alberta, Western Canada, AB, Canada
| | - Leif Bjermer
- Department of Clinical Sciences, Respiratory Medicine and Allergology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Anne Sofie Bjerrum
- Department of Respiratory Medicine and Allergy, Aarhus University Hospital, Jutland, Aarhus, Denmark
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Lakmini Bulathsinhala
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- Centre for Public Health, Queen’s University Belfast, Belfast, Northern Ireland
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Victoria Carter
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Department of Respiratory Medicine, Clinical Research Centre, Smurfit Building Beaumont Hospital, RCSI, Dublin, Ireland
| | - J Mark FitzGerald
- Department of Medicine, the University of British Columbia, Vancouver, BC, Canada
| | - João A Fonseca
- Comunity Health, Information and Decision Sciences Department (MEDCIDS) & Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine of University of Porto, Porto, Portugal
| | - Kwang Ha Yoo
- KonKuk University School of Medicine in Seoul, Seoul, Korea
| | - Liam G Heaney
- Wellcome-Wolfson Centre for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Milan, Italy,Department of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia,Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ole Hilberg
- Medical Department, Vejle University Hospital, Jutland, Vejle, Denmark
| | - Flavia Hoyte
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA,Department of Internal Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Takashi Iwanaga
- Center for General Medical Education and Clinical Training, Kindai University Hospital, Osakasayama, Japan
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy’s and St Thomas’ NHS Trust, London, UK,School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Rupert C Jones
- Research and Knowledge Exchange, Plymouth Marjon University, Plymouth, UK
| | - Mariko Siyue Koh
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Singapore,SingHealth Duke-NUS Lung Centre, Singapore, Singapore
| | - Piotr Kuna
- Division of Internal Medicine, Asthma and Allergy Medical University of Łódź, Łódź, Poland
| | | | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lauri A Lehtimäki
- Allergy Centre, Tampere University Hospital, Tampere, Finland,Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juntao Lyu
- Observational and Pragmatic Research Institute, Singapore, Singapore,Optimum Patient Care, Queensland, VIC, Australia
| | - Bassam Mahboub
- College of Medicine, University of Sharjah, Sharjah, United Arab Emirates,Rashid Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Jorge Maspero
- Clinical Research for Allergy and Respiratory Medicine, CIDEA Foundation, Buenos Aires, Argentina,University Career of Specialists in Allergy and Clinical Immunology at the Buenos Aires University School of Medicine, Buenos Aires, Argentina
| | | | | | - Nikolaos Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, UK,Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Luis Pérez de Llano
- Pneumology Service, Lucus Augusti University Hospital, EOXI Lugo, Lugo, Spain,Biodiscovery Research Group, Health Research Institute of Santiago de Compostela, Santiago de Compostela, Spain
| | - Diahn-Warng Perng
- Division of Clinical Respiratory Physiology Chest Department, Taipei Veterans General Hospital, Taipei, Taiwan,COPD Assembly of the Asian Pacific Society of RespirologyHongo, Bunkyo-ku, Tokyo, Japan
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia
| | - Paul E Pfeffer
- Department of Respiratory Medicine, Barts Health NHS Trust, London, UK,Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Todor A Popov
- University Hospital ”sv. Ivan Rilski”, Sofia, Bulgaria
| | - Chin Kook Rhee
- Department of Internal Medicine, Division of Pulmonary and Critical Care Medicine, Seoul St. Mary’s Hospital, College of Medicine, the Catholic University of Korea, Seoul, South Korea
| | - Sundeep Salvi
- Pulmocare Research and Education Foundation, Pune, India
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris, Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Essen, Germany
| | - Carlos A Torres-Duque
- CINEUMO, Respiratory Research Center, Fundación Neumológica Colombiana, Bogotá, Colombia
| | - Charlotte S Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - Seung Won Ra
- Department of Internal Medicine, Division of Pulmonology, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Eileen Wang
- Department of Medicine, Division of Allergy and Clinical Immunology, National Jewish Health, Denver, CO, USA,Department of Internal Medicine, Division of Allergy & Clinical Immunology, University of Colorado School of Medicine, Aurora, CO, USA
| | - Michael E Wechsler
- Department of Medicine, NJH Cohen Family Asthma Institute, National Jewish Health, Denver, CO, USA
| | - David B Price
- Optimum Patient Care, Cambridge, UK,Observational and Pragmatic Research Institute, Singapore, Singapore,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK,Correspondence: David B Price, Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore, Singapore, 573969, Tel +65 3105 1489, Email
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9
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Paoletti G, Pepys J, Casini M, Di Bona D, Heffler E, Goh CYY, Price DB, Canonica GW. Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31:31/164/210278. [PMID: 35675922 DOI: 10.1183/16000617.0278-2021] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 04/20/2022] [Indexed: 11/05/2022] Open
Abstract
Asthma is one of the most common noncommunicable diseases; in the majority of patients it is well controlled with inhaled bronchodilators and inhaled corticosteroids, but the management of severe asthma has been a significant challenge historically. The introduction of novel biologic drugs in the past few decades has revolutionised the field, presenting physicians with a variety of biologic drugs with different mechanisms for the treatment of severe asthma.It is of crucial importance to evaluate the effectiveness of these drugs by following their "real-life" effectiveness rather than relying solely on their efficacy, established in carefully designed clinical trials, which therefore do not necessarily match the profile of the real-life patient. Understanding the actual effectiveness of the specific drugs in real-life patients is a crucial part of tailoring the right drugs to the right patients. Registries serve as an important tool in obtaining real-life evidence, since they are in effect observational studies, following the entire patient population.
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Affiliation(s)
- Giovanni Paoletti
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Jack Pepys
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Marta Casini
- Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Danilo Di Bona
- School and Chair of Allergology and Clinical Immunology, Dept of Emergency and Organ Transplantation, University of Bari Aldo Moro, Bari, Italy
| | - Enrico Heffler
- IRCCS Humanitas Research Hospital, Milan, Italy.,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
| | - Celine Y Y Goh
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David B Price
- Optimum Patient Care Global, Cambridge, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore.,Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Giorgio Walter Canonica
- IRCCS Humanitas Research Hospital, Milan, Italy .,Dept of Biomedical Sciences, Humanitas University, Milan, Italy
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10
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Duverdier A, Custovic A, Tanaka RJ. Data-driven research on eczema: Systematic characterization of the field and recommendations for the future. Clin Transl Allergy 2022; 12:e12170. [PMID: 35686200 PMCID: PMC9172212 DOI: 10.1002/clt2.12170] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/23/2022] [Accepted: 05/25/2022] [Indexed: 11/26/2022] Open
Abstract
Background The past decade has seen a substantial rise in the employment of modern data-driven methods to study atopic dermatitis (AD)/eczema. The objective of this study is to summarise the past and future of data-driven AD research, and identify areas in the field that would benefit from the application of these methods. Methods We retrieved the publications that applied multivariate statistics (MS), artificial intelligence (AI, including machine learning-ML), and Bayesian statistics (BS) to AD and eczema research from the SCOPUS database over the last 50 years. We conducted a bibliometric analysis to highlight the publication trends and conceptual knowledge structure of the field, and applied topic modelling to retrieve the key topics in the literature. Results Five key themes of data-driven research on AD and eczema were identified: (1) allergic co-morbidities, (2) image analysis and classification, (3) disaggregation, (4) quality of life and treatment response, and (5) risk factors and prevalence. ML&AI methods mapped to studies investigating quality of life, prevalence, risk factors, allergic co-morbidities and disaggregation of AD/eczema, but seldom in studies of therapies. MS was employed evenly between the topics, particularly in studies on risk factors and prevalence. BS was focused on three key topics: treatment, risk factors and allergy. The use of AD or eczema terms was not uniform, with studies applying ML&AI methods using the term eczema more often. Within MS, papers using cluster and factor analysis were often only identified with the term AD. In contrast, those using logistic regression and latent class/transition models were "eczema" papers. Conclusions Research areas that could benefit from the application of data-driven methods include the study of the pathogenesis of the condition and related risk factors, its disaggregation into validated subtypes, and personalised severity management and prognosis. We highlight BS as a new and promising approach in AD and eczema research.
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Affiliation(s)
- Ariane Duverdier
- Department of ComputingImperial College LondonLondonUK
- Department of BioengineeringImperial College LondonLondonUK
- UKRI Centre for Doctoral Training in AI for HealthcareImperial College LondonLondonUK
| | - Adnan Custovic
- National Heart and Lung InstituteImperial College LondonLondonUK
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11
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Menzies-Gow AN, McBrien C, Unni B, Porsbjerg CM, Al-Ahmad M, Ambrose CS, Dahl Assing K, von Bülow A, Busby J, Cosio BG, FitzGerald JM, Garcia Gil E, Hansen S, aHeaney LG, Hew M, Jackson DJ, Kallieri M, Loukides S, Lugogo NL, Papaioannou AI, Larenas-Linnemann D, Moore WC, Perez-de-Llano LA, Rasmussen LM, Schmid JM, Siddiqui S, Alacqua M, Tran TN, Suppli Ulrik C, Upham JW, Wang E, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Murray RB, Price CA, Price DB. Real World Biologic Use and Switch Patterns in Severe Asthma: Data from the International Severe Asthma Registry and the US CHRONICLE Study. J Asthma Allergy 2022; 15:63-78. [PMID: 35046670 PMCID: PMC8763264 DOI: 10.2147/jaa.s328653] [Citation(s) in RCA: 40] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/23/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction International registries provide opportunities to describe use of biologics for treating severe asthma in current clinical practice. Our aims were to describe real-life global patterns of biologic use (continuation, switches, and discontinuations) for severe asthma, elucidate reasons underlying these patterns, and examine associated patient-level factors. Methods This was a historical cohort study including adults with severe asthma enrolled into the International Severe Asthma Registry (ISAR; http://isaregistries.org, 2015–2020) or the CHRONICLE Study (2018–2020) and treated with a biologic. Eleven countries were included (Bulgaria, Canada, Denmark, Greece, Italy, Japan, Kuwait, South Korea, Spain, UK, and USA). Biologic utilization patterns were defined: 1) continuing initial biologic; 2) stopping biologic treatment; or 3) switching to another biologic. Reasons for discontinuation/switching were recorded and comparisons drawn between groups. Results A total of 3531 patients were included. Omalizumab was the most common initial biologic in 2015 (88.2%) and benralizumab in 2019 (29.6%). Most patients (79%; 2791/3531) continued their first biologic; 10.2% (356/3531) stopped; 10.8% (384/3531) switched. The most frequent first switch was from omalizumab to an anti–IL-5/5R (49.6%; 187/377). The most common subsequent switch was from one anti–IL-5/5R to another (44.4%; 20/45). Insufficient efficacy and/or adverse effects were the most frequent reasons for stopping/switching. Patients who stopped/switched were more likely to have a higher baseline blood eosinophil count and exacerbation rate, lower lung function, and greater health care resource utilization. Conclusion The description of real-life patterns of continuing, stopping, or switching biologics enhances our understanding of global biologic use. Prospective studies involving structured switching criteria could ascertain optimal strategies to identify patients who may benefit from switching.
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Affiliation(s)
- Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals, London, UK
| | | | - Bindhu Unni
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait, Kuwait
| | | | - Karin Dahl Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Anna von Bülow
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen’s University Belfast, Belfast, Northern Ireland
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - J Mark FitzGerald
- The Centre for Lung Health, Vancouver Coastal Health Research Institute, UBC, Vancouver, Canada
| | | | - Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
| | - Liam G aHeaney
- UK Severe Asthma Network and National Registry, Queen’s University Belfast, Belfast, Northern Ireland
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia
- Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - David J Jackson
- UK Severe Asthma Network andNational Registry, Guy’s and St Thomas’ NHS Trust, London, UK
- School of Immunology & Microbial Sciences, King’s College London, London, UK
| | - Maria Kallieri
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Stelios Loukides
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Njira L Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | | | - Wendy C Moore
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Luis A Perez-de-Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Linda M Rasmussen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Copenhagen, Denmark
| | | | - Salman Siddiqui
- University of Leicester, Department of Respiratory Sciences & NIHR Leicester Biomedical Research Centre (Respiratory Theme), Leicester, UK
| | | | | | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Copenhagen University Hospital-Hvidovre, Hvidovre, Denmark
| | - John W Upham
- Diamantina Institute & PA-Southside Clinical Unit, The University of Queensland, Brisbane, Australia
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, USA
- Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado School of Medicine, Aurora, CO, USA
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Victoria A Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Ruth B Murray
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - Chris A Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore
- Optimum Patient Care, Cambridge, UK
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
- Correspondence: David B Price Observational and Pragmatic Research Institute, 22 Sin Ming Lane, #06 Midview City, Singapore, 573969Tel +65 3105 1489 Email
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12
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Hill MK, Laughter MR, Harmange CI, Dellavalle RP, Rundle CW, Dunnick CA. The Contact Dermatitis Quality of Life Index (CDQL): Survey Development and Content Validity Assessment. JMIR Dermatol 2021; 4:e30620. [PMID: 37632827 PMCID: PMC10334971 DOI: 10.2196/30620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2021] [Revised: 10/19/2021] [Accepted: 11/17/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND There is limited measurement and reporting of quality of life (QoL) outcomes for patients with contact dermatitis (CD). OBJECTIVE The purpose of this study is to develop a standardized Contact Dermatitis Quality of Life index (CDQL) for adult patients. METHODS A list of 81 topics was compiled from a review of QoL measures used previously in CD research. A total of 2 rounds of web-based Delphi surveys were sent to physicians who registered to attend the 2018 American Contact Dermatitis Society meeting, asking that they rank the relevance of topics for measuring QoL in CD using a 4-point scale. Items met consensus for inclusion if at least 78% of respondents ranked them as relevant or very relevant, and their median score was ≥3.25. RESULTS Of the 210 physicians contacted, 34 physicians completed the initial survey and 17 completed the follow-up survey. A total of 22 topics met consensus for inclusion in the CDQL, addressing symptoms, emotions, functions of daily living, social and physical functions, work/school functions, and treatment. CONCLUSIONS This study was limited by the following factors: few open-ended questions in the initial survey, a lack of direct patient feedback, and long survey length, which likely contributed to lower survey participation. The CDQL is a comprehensive, CD-specific QoL measure developed on the basis of expert consensus via a modified Delphi process to be used by physicians and other health care professionals who care for adult patients with contact dermatitis.
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Affiliation(s)
- Mary K Hill
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | | | - Cecile I Harmange
- School of Medicine, University of Colorado, Aurora, CO, United States
| | - Robert P Dellavalle
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, United States Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, United States
- Department of Epidemiology, Colorado School of Public Health, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
| | - Chandler W Rundle
- School of Medicine, Loma Linda University, Loma Linda, CA, United States
| | - Cory A Dunnick
- Department of Dermatology, University of Colorado Anschutz Medical Campus, Aurora, CO, United States
- Dermatology Service, United States Department of Veterans Affairs, Eastern Colorado Health Care System, Aurora, CO, United States
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13
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Backer V, Aanaes K, Hansen S, Petersen J, von Buchwald C. Global airways – a novel Standard Tests for Asthma, allergic Rhinitis, and chronic Rhinosinusitis (STARR-15). Rhinology 2021; 60:63-72. [DOI: 10.4193/rhin21.195] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Background: Global airway disease, with symptoms from both upper and lower airways, is a challenging problem for clinicians. Our goal is to design one single standard test for the awareness of global airway diseases to be used in clinical setting. Material and Methods: During 2019, rhinologists and pulmonologists generated a pool of items based on literature, patient-reported outcome measures and clinical experience. The items were administered to 206 patients with known asthma, CRS, allergic rhinitis, or a combination thereof. The patients also completed the Asthma Control Questionnaire (ACQ-5) and the Sino-Nasal Outcome Test (SNOT-22). Using a mix of clinical knowledge and data-driven methods a global airways questionnaire was developed. Results: Mean ACQ score was highest in patients with all three, whereas the highest SNOT-22 score was observed in patients with CRS and asthma. After the development process, analysis of responses from 206 patients to 44 items on a new global airway’s questionnaire led to identification of 15 items that form the STARR-15 questionnaire with three underlying domains (an allergic rhinitis sub-factor, a CRS sub-factor and an asthma sub-factor). Conclusion: STARR-15 represents the first global airways questionnaire, to be used when examining patients with upper and lower airways symptoms. Future analyses are warranted to evaluate the clinical and psychometric properties of STARR-15.
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Bossios A. Inflammatory T2 Biomarkers in Severe Asthma Patients: The First Step to Precision Medicine. J Allergy Clin Immunol Pract 2021; 9:2689-2690. [PMID: 34246437 DOI: 10.1016/j.jaip.2021.04.044] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 04/23/2021] [Indexed: 01/21/2023]
Affiliation(s)
- Apostolos Bossios
- Department of Respiratory Medicine and Allergy, Karolinska University Hospital, Huddinge, and Department of Medicine, Huddinge, Karolinska Institutet, Stockholm, Sweden.
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15
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Heaney LG, Perez de Llano L, Al-Ahmad M, Backer V, Busby J, Canonica GW, Christoff GC, Cosio BG, FitzGerald JM, Heffler E, Iwanaga T, Jackson DJ, Menzies-Gow AN, Papadopoulos NG, Papaioannou AI, Pfeffer PE, Popov TA, Porsbjerg CM, Rhee CK, Sadatsafavi M, Tohda Y, Wang E, Wechsler ME, Alacqua M, Altraja A, Bjermer L, Björnsdóttir US, Bourdin A, Brusselle GG, Buhl R, Costello RW, Hew M, Siyue MK, Lehmann S, Lehtimäki L, Peters M, Taillé C, Taube C, Tran TN, Zangrilli J, Bulathsinhala L, Carter VA, Chaudhry I, Eleangovan N, Hosseini N, Kerkhof M, Murray RB, Price CA, Price DB. Eosinophilic and Noneosinophilic Asthma: An Expert Consensus Framework to Characterize Phenotypes in a Global Real-Life Severe Asthma Cohort. Chest 2021; 160:814-830. [PMID: 33887242 DOI: 10.1016/j.chest.2021.04.013] [Citation(s) in RCA: 96] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 03/30/2021] [Accepted: 04/05/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Phenotypic characteristics of patients with eosinophilic and noneosinophilic asthma are not well characterized in global, real-life severe asthma cohorts. RESEARCH QUESTION What is the prevalence of eosinophilic and noneosinophilic phenotypes in the population with severe asthma, and can these phenotypes be differentiated by clinical and biomarker variables? STUDY DESIGN AND METHODS This was an historical registry study. Adult patients with severe asthma and available blood eosinophil count (BEC) from 11 countries enrolled in the International Severe Asthma Registry (January 1, 2015-September 30, 2019) were categorized according to likelihood of eosinophilic phenotype using a predefined gradient eosinophilic algorithm based on highest BEC, long-term oral corticosteroid use, elevated fractional exhaled nitric oxide, nasal polyps, and adult-onset asthma. Demographic and clinical characteristics were defined at baseline (ie, 1 year before or closest to date of BEC). RESULTS One thousand seven hundred sixteen patients with prospective data were included; 83.8% were identified as most likely (grade 3), 8.3% were identified as likely (grade 2), and 6.3% identified as least likely (grade 1) to have an eosinophilic phenotype, and 1.6% of patients showed a noneosinophilic phenotype (grade 0). Eosinophilic phenotype patients (ie, grades 2 or 3) showed later asthma onset (29.1 years vs 6.7 years; P < .001) and worse lung function (postbronchodilator % predicted FEV1, 76.1% vs 89.3%; P = .027) than those with a noneosinophilic phenotype. Patients with noneosinophilic phenotypes were more likely to be women (81.5% vs 62.9%; P = .047), to have eczema (20.8% vs 8.5%; P = .003), and to use anti-IgE (32.1% vs 13.4%; P = .004) and leukotriene receptor antagonists (50.0% vs 28.0%; P = .011) add-on therapy. INTERPRETATION According to this multicomponent, consensus-driven, and evidence-based eosinophil gradient algorithm (using variables readily accessible in real life), the severe asthma eosinophilic phenotype was more prevalent than previously identified and was phenotypically distinct. This pragmatic gradient algorithm uses variables readily accessible in primary and specialist care, addressing inherent issues of phenotype heterogeneity and phenotype instability. Identification of treatable traits across phenotypes should improve therapeutic precision.
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Affiliation(s)
- Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, United Kingdom
| | - Luis Perez de Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Centre for Physical Activity Research, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; Department of ENT, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, United Kingdom
| | - Giorgio Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | | | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | | | - Enrico Heffler
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Takashi Iwanaga
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust, London, United Kingdom; School of Immunology & Microbial Sciences, King's College London, London, United Kingdom
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Nikolaos G Papadopoulos
- Division of Infection, Immunity & Respiratory Medicine, University of Manchester, Manchester, United Kingdom; Allergy Department, 2nd Pediatric Clinic, University of Athens, Athens, Greece
| | - Andriana I Papaioannou
- 2nd Respiratory Medicine Department, National and Kapodistrian University of Athens Medical School, Attikon University Hospital, Athens, Greece
| | - Paul E Pfeffer
- Queen Mary University of London, London, United Kingdom; UK Severe Asthma Network, Barts Health NHS Trust, London, United Kingdom
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | - Celeste M Porsbjerg
- Respiratory Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark
| | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Yuji Tohda
- Department of Respiratory Medicine and Allergology, Kindai University Faculty of Medicine, Osakasayama, Japan
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO; Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO
| | - Michael E Wechsler
- NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO
| | | | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Leif Bjermer
- Respiratory Medicine and Allergology, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Unnur S Björnsdóttir
- Department of Respiratory Medicine and Allergy, Landspitali The University Hospital of Iceland, Reykjavik, Iceland
| | - Arnaud Bourdin
- PhyMedExp, Univ Montpellier, CNRS, INSERM, CHU Montpellier, Montpellier, France
| | - Guy G Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Roland Buhl
- Pulmonary Department, Mainz University Hospital, Mainz, Germany
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital and Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | - Mark Hew
- Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Mariko Koh Siyue
- Respiratory & Critical Care Medicine, Singapore General Hospital, Singapore, Republic of Singapore; SingHealth Duke-NUS Lung Centre, Singapore, Republic of Singapore
| | - Sverre Lehmann
- Section of Thoracic Medicine, Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital, and Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Matthew Peters
- Department of Thoracic Medicine, Concord Hospital, Sydney, Australia
| | - Camille Taillé
- Department of Respiratory Diseases, Bichat Hospital, AP-HP Nord-Université de Paris; Paris, France
| | - Christian Taube
- Department of Pulmonary Medicine, University Medical Center Essen-Ruhrlandklinik, Germany
| | | | | | | | | | | | | | | | | | | | | | - David B Price
- Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom; Observational and Pragmatic Research Institute, Singapore, Republic of Singapore.
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Shelef DQ, Badolato GM, Badh R, Owotomo O, Kachroo N, Weissman M, Teach SJ, Shah AY. Creation and validation of a citywide pediatric asthma registry for the District of Columbia. J Asthma 2021; 59:901-909. [PMID: 33635727 DOI: 10.1080/02770903.2021.1895213] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To create and validate a citywide pediatric Asthma Registry to improve the care and outcomes of children and adolescents in Washington, DC through data-driven quality improvement (QI). METHODS All available electronic health record data from inpatient and outpatient domains of Children's National Hospital were aggregated from an existing enterprise data warehouse. Inclusion criteria included asthma relevant ICD-10 codes over the prior 24 months. Available Asthma Registry measures include patient demographics, ambulatory visits, hospital admissions, persistent asthma diagnoses, and prescription of controller medications. Data capture was validated using US Census data and current asthma prevalence estimate of the Behavioral Risk Factor Surveillance System (BRFSS). RESULTS The registry identified 15,991 DC children and adolescents with asthma aged 0-17 years, inclusive, at the end of 2020. This was 14.2% higher than the estimate of 14,001 children derived from BRFSS. Characteristics of those in the registry included: mean age of 9.5 (1.4) years, 57.9% male, 72.3% Black, and 66.7% publicly insured. Over the prior 24 months, 30.3% had ≥1 emergency department visit, and 10.5% had ≥1 hospital admission. Controller medications were prescribed for 59.6% of children with persistent asthma. Rates varied by sampled primary care practice sites. CONCLUSIONS A population-level pediatric asthma registry captures more children and adolescents with asthma in DC then a BRFSS-derived estimate, and provides city-wide measures of asthma-related utilization. The registry allows for stratification by primary care practice locations and asthma characteristics, supporting the design, implementation, and evaluation of QI projects at the practice, health system, and population levels. Supplemental data for this article can be accessed at publisher's website.
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Affiliation(s)
- Deborah Q Shelef
- Children's National Hospital, Washington, DC, USA.,University of Maryland School of Public Health, College Park, MD, USA
| | | | - Ranjodh Badh
- Children's National Hospital, Washington, DC, USA
| | | | | | - Mark Weissman
- Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Stephen J Teach
- Children's National Hospital, Washington, DC, USA.,George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Ankoor Y Shah
- District of Columbia Department of Health, Washington, DC, USA
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17
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Denton E, Price DB, Tran TN, Canonica GW, Menzies-Gow A, FitzGerald JM, Sadatsafavi M, Perez de Llano L, Christoff G, Quinton A, Rhee CK, Brusselle G, Ulrik C, Lugogo N, Hore-Lacy F, Chaudhry I, Bulathsinhala L, Murray RB, Carter VA, Hew M. Cluster Analysis of Inflammatory Biomarker Expression in the International Severe Asthma Registry. J Allergy Clin Immunol Pract 2021; 9:2680-2688.e7. [PMID: 33744476 DOI: 10.1016/j.jaip.2021.02.059] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 02/18/2021] [Indexed: 01/02/2023]
Abstract
BACKGROUND Allergy, eosinophilic inflammation, and epithelial dysregulation are implicated in severe asthma pathogenesis. OBJECTIVE We characterized biomarker expression in adults with severe asthma. METHODS Within the International Severe Asthma Registry (ISAR), we analyzed data from 10 countries in North America, Europe, and Asia, with prespecified thresholds for biomarker positivity (serum IgE ≥ 75 kU/L, blood eosinophils ≥ 300 cells/μL, and FeNO ≥ 25 ppb), and with hierarchical cluster analysis using biomarkers as continuous variables. RESULTS Of 1,175 patients; 64% were female, age (mean ± SD) 53 ± 15 years, body mass index (BMI) 30 ± 8, postbronchodilator forced expiratory volume in 1 second (FEV1) predicted 72% ± 20%. By prespecified thresholds, 59% were IgE positive, 57% eosinophil positive, and 58% FeNO positive. There was substantial inflammatory biomarker overlap; 59% were positive for either 2 or 3 biomarkers. Five distinct clusters were identified: cluster 1 (61%, low-to-medium biomarkers) comprised highly symptomatic, older females with elevated BMI and frequent exacerbations; cluster 2 (18%, elevated eosinophils and FeNO) older females with lower BMI and frequent exacerbations; cluster 3 (14%, extremely high FeNO) older, highly symptomatic, lower BMI, and preserved lung function; cluster 4 (6%, extremely high IgE) younger, long duration of asthma, elevated BMI, and poor lung function; cluster 5 (1.2%, extremely high eosinophils) younger males with low BMI, poor lung function, and high burden of sinonasal disease and polyposis. CONCLUSIONS There is significant overlap of biomarker positivity in severe asthma. Distinct clusters according to biomarker expression exhibit unique clinical characteristics, suggesting the occurrence of discrete patterns of underlying inflammatory pathway activation and providing pathogenic insights relevant to the era of monoclonal biologics.
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Affiliation(s)
- Eve Denton
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
| | - David B Price
- Optimum Patient Care, Cambridge, UK; Observational and Pragmatic Research Institute, Singapore, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | | | - G Walter Canonica
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center IRCCS, Rozzano, Milan, Italy; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
| | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - J Mark FitzGerald
- The Centre for Heart Lung Health, Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Luis Perez de Llano
- Department of Respiratory Medicine, Hospital Universitario Lucus Augusti, Lugo, Spain
| | - George Christoff
- Faculty of Public Health, Medical University of Sofia, Sofia, Bulgaria
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Department of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Charlotte Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
| | - Njira Lugogo
- Department of Medicine, Division of Pulmonary and Critical Care Medicine, University of Michigan, Ann Arbor, Mich
| | - Fiona Hore-Lacy
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | | | | | | | | | - Mark Hew
- Allergy, Asthma, and Clinical Immunology, Alfred Health, Melbourne, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, Australia
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18
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Ryan D, Heatley H, Heaney LG, Jackson DJ, Pfeffer PE, Busby J, Menzies-Gow AN, Jones R, Tran TN, Al-Ahmad M, Backer V, Belhassen M, Bosnic-Anticevich S, Bourdin A, Bulathsinhala L, Carter V, Chaudhry I, Eleangovan N, FitzGerald JM, Gibson PG, Hosseini N, Kaplan A, Murray RB, Rhee CK, Van Ganse E, Price DB. Potential Severe Asthma Hidden in UK Primary Care. J Allergy Clin Immunol Pract 2020; 9:1612-1623.e9. [PMID: 33309935 DOI: 10.1016/j.jaip.2020.11.053] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 11/24/2020] [Accepted: 11/25/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Severe asthma may be underrecognized in primary care. OBJECTIVE Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care. METHODS This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared. RESULTS Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA. CONCLUSIONS Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
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Affiliation(s)
- Dermot Ryan
- Usher Institute, University of Edinburgh, United Kingdom
| | - Heath Heatley
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Liam G Heaney
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College London, London, United Kingdom
| | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom
| | - John Busby
- UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland
| | - Andrew N Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom
| | - Rupert Jones
- Faculty of Health, University of Plymouth, Plymouth, United Kingdom
| | | | - Mona Al-Ahmad
- Al-Rashed Allergy Center, Ministry of Health, Microbiology Department, Faculty of Medicine, Kuwait University, Kuwait
| | - Vibeke Backer
- Department of ENT & Centre for Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Manon Belhassen
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - Sinthia Bosnic-Anticevich
- Woolcock Institute of Medical Research, University of Sydney and Sydney Local Health District, Glebe, NSW, Australia
| | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Arnaud de Villeneuve Hospital, Montpellier, France
| | - Lakmini Bulathsinhala
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Victoria Carter
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | - Isha Chaudhry
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Neva Eleangovan
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom
| | | | - Peter G Gibson
- Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia; Hunter Medical Research Institute, Department of Respiratory and Sleep Medicine, John Hunter Hospital, New Lambton Heights, NSW, Australia
| | | | - Alan Kaplan
- Family Physician Airways Group of Canada, Stouffville, ON, Canada; University of Toronto, Toronto, ON, Canada
| | | | - Chin Kook Rhee
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eric Van Ganse
- PELyon, HESPER 7425, Claude Bernard University, Lyon, France
| | - David B Price
- Observational and Pragmatic Research Institute, Singapore, Singapore; Optimum Patient Care, Cambridge, United Kingdom; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom.
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19
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Jackson DJ, Busby J, Pfeffer PE, Menzies-Gow A, Brown T, Gore R, Doherty M, Mansur AH, Message S, Niven R, Patel M, Heaney LG. Characterisation of patients with severe asthma in the UK Severe Asthma Registry in the biologic era. Thorax 2020; 76:220-227. [PMID: 33298582 PMCID: PMC7892381 DOI: 10.1136/thoraxjnl-2020-215168] [Citation(s) in RCA: 73] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 09/15/2020] [Accepted: 10/14/2020] [Indexed: 02/06/2023]
Abstract
Background The UK Severe Asthma Registry (UKSAR) is the world’s largest national severe asthma registry collecting standardised data on referrals to UK specialist services. Novel biologic therapies have transformed the management of type 2(T2)-high severe asthma but have highlighted unmet need in patients with persisting symptoms despite suppression of T2-cytokine pathways with corticosteroids. Methods Demographic, clinical and treatments characteristics for patients meeting European Respiratory Society / American Thoracic Society severe asthma criteria were examined for 2225 patients attending 15 specialist severe asthma centres. We assessed differences in biomarker low patients (fractional exhaled nitric oxide (FeNO) <25 ppb, blood eosinophils <150/μL) compared with a biomarker high population (FeNO ≥25 ppb, blood eosinophils ≥150/µL). Results Age (mean 49.6 (14.3) y), age of asthma onset (24.2 (19.1) y) and female predominance (62.4%) were consistent with prior severe asthma cohorts. Poor symptom control (Asthma Control Questionnaire-6: 2.9 (1.4)) with high exacerbation rate (4 (IQR: 2, 7)) were common despite high-dose treatment (51.7% on maintenance oral corticosteroids (mOCS)). 68.9% were prescribed biologic therapies including mepolizumab (50.3%), benralizumab (26.1%) and omalizumab (22.6%). T2-low patients had higher body mass index (32.1 vs 30.2, p<0.001), depression/anxiety prevalence (12.3% vs 7.6%, p=0.04) and mOCS use (57.9% vs 42.1%, p<0.001). Many T2-low asthmatics had evidence of a historically elevated blood eosinophil count (0.35 (0.13, 0.60)). Conclusions The UKSAR describes the characteristics of a large cohort of asthmatics referred to UK specialist severe asthma services. It offers the prospect of providing novel insights across a range of research areas and highlights substantial unmet need with poor asthma control, impaired lung function and high exacerbation rates. T2-high phenotypes predominate with significant differences apparent from T2-low patients. However, T2-low patients frequently have prior blood eosinophilia consistent with possible excessive corticosteroid exposure.
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Affiliation(s)
- David J Jackson
- Guy's Severe Asthma Centre, Guy's and St Thomas' NHS Foundation Trust, UK.,Asthma UK Centre, King's College London, UK
| | - John Busby
- Centre for Public Health, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, UK
| | - Paul E Pfeffer
- Respiratory Medicine, Barts Health NHS Trust, London, UK
| | - Andrew Menzies-Gow
- Lung Division, Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Thomas Brown
- Respiratory Medicine, Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Robin Gore
- Respiratory Medicine, Cambridge University Hospitals Trust, Cambridge, UK
| | - Martin Doherty
- Respiratory Medicine, Russells Hall Hospital, Dudley, UK
| | - Adel H Mansur
- Heartlands Hospital, Heart of England NHS Foundation Trust, Birmingham, UK.,University of Birmingham, UK
| | - Simon Message
- Respiratory Medicine, Gloucestershore Royal Hospital, Gluocester, UK
| | - Robert Niven
- Wythenshawe Hospital, Manchester NHS Foundation Trust, UK
| | - Mitesh Patel
- Respiratory Medicine, University Plymouth NHS Trust, Plymouth, UK
| | - Liam G Heaney
- Centre for Experimental Medicine, Queen's University Belfast School of Medicine, Dentistry and Biomedical Sciences, UK .,Belfast Health & Social Care NHS Trust, UK
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20
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Hansen S, Hilberg O, Ulrik CS, Bodtger U, M. Rasmussen L, D. Assing K, Wimmer-Aune A, B. Rasmussen K, Bjerring N, Christiansen A, Schmid J, Krogh NS, Porsbjerg C. The Danish severe asthma register: an electronic platform for severe asthma management and research. Eur Clin Respir J 2020; 8:1842117. [PMID: 33209214 PMCID: PMC7646603 DOI: 10.1080/20018525.2020.1842117] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 10/22/2020] [Indexed: 12/27/2022] Open
Abstract
The evaluation and management of severe asthma patients require collection of comprehensive information, which is often a challenge in a busy outpatient clinic. The Danish Severe Asthma Register (DSAR) was designed as an electronic patient record form that captures operational clinical data and provides a clinical overview of the severe asthma patient. DSAR is a nationwide register; all patients in Denmark who are treated with biologics for severe asthma are included, and data are as a minimum entered at start of biological treatment, after four and 12 months of treatment, and hereafter annually. Currently, there are data from 621 treatment courses with biologics included in DSAR, with 71% of patients treated with anti-IL-5 drugs and 29% with an anti-IgE drug. Patients enter Patient Reported Outcome Measures electronically on tablets when they arrive in the outpatient clinic and their answers are immediately available to the clinician during the consultation. Nurses and doctors enter clinical data into DSAR during the consultation. DSAR offers immediate access to well-presented longitudinal overview and automatically creates a journal output that can be copy-pasted into the hospital's existing health record form. DSAR is also currently expanding with an app, to be used for monitoring of home-treatment. In addition to serving as an electronic patient record form, DSAR will also provide opportunities to monitor the real-life efficacy of biological treatment for severe asthma in Denmark, and it will be a valuable research platform that will aid in answering important research questions on severe asthma in the future.
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Affiliation(s)
- Susanne Hansen
- Center for Clinical Research and Prevention, Bispebjerg and Frederiksberg Hospital, Copenhagen, Denmark
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
| | - Ole Hilberg
- Department of Respiratory Medicine, Vejle Hospital, Vejle, Denmark
| | - Charlotte Suppli Ulrik
- Department of Respiratory Medicine, Hvidovre Hospital, Hvidovre, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Uffe Bodtger
- Institute of Regional Health Services Research, University of Southern Denmark, Odense, Denmark
- Department of Respiratory Medicine, Naestved Hospital, Naestved, Denmark
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Linda M. Rasmussen
- Allergy Clinic, Department of Dermato-Allergology, Gentofte Hospital, Copenhagen, Denmark
| | - Karin D. Assing
- Department of Respiratory Medicine, Aalborg University Hospital, Aalborg, Denmark
| | | | - Kirsten B. Rasmussen
- Department of Respiratory Medicine, Zealand University Hospital, Roskilde, Denmark
| | - Niels Bjerring
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Anders Christiansen
- Department of Respiratory Medicine, Odense University Hospital, Odense, Denmark
| | - Johannes Schmid
- Department of Respiratory Diseases and Allergy, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark
| | - Niels Steen Krogh
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Celeste Porsbjerg
- Respiratory Research Unit, Department of Respiratory Medicine, Bispebjerg & Frederiksberg Hospital, Copenhagen, Denmark
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21
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Canonica GW, Blasi F, Paggiaro P, Senna G, Passalacqua G, Spanevello A, Aliberti S, Bagnasco D, Bonavia M, Bonini M, Brussino L, Bucca C, Caiaffa MF, Calabrese C, Camiciottoli G, Caminati M, Carpagnano GE, Caruso C, Centanni S, Conte ME, Corsico AG, Cosmi L, Costantino MT, Crimi N, D’Alò S, D'Amato M, Del Giacco S, Farsi A, Favero E, Foschino Barbaro MP, Guarnieri G, Guida G, Latorre M, Lo Cicero S, Lombardi C, Macchia L, Mazza F, Menzella F, Milanese M, Montagni M, Montuschi P, Nucera E, Parente R, Patella V, Pelaia G, Pini L, Puggioni F, Ricciardi L, Ricciardolo FL, Richeldi L, Ridolo E, Rolla G, Santus P, Scichilone N, Spadaro G, Vianello A, Viviano V, Yacoub MR, Zappa MC, Heffler E. Oral CorticoSteroid sparing with biologics in severe asthma: A remark of the Severe Asthma Network in Italy ( SANI). World Allergy Organ J 2020; 13:100464. [PMID: 32999699 PMCID: PMC7509464 DOI: 10.1016/j.waojou.2020.100464] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/30/2022] Open
Abstract
According to the data derived from several national and international registries, including SANI (Severe Asthma Network Italy), and considering the strong impact that frequent or regular use of oral corticosteroid has on quality of life (QoL) of severe asthmatics, as well as on the costs for managing corticosteroid-related diseases, oral corticosteroid sparing up to withdrawal should be considered a primary outcome in the management of severe asthma. New biologics have clearly demonstrated that this effect is possible, with concomitant reduction in the rate of exacerbations and in symptom control. Then, there is no reason for using so frequently oral corticosteroid before having explored all alternatives currently available for a large part of severe asthmatics.
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Key Words
- Biologics
- CRSwNP, chronic rhinosinusitis with nasal polyposis
- EMA, European Medicines Agency
- FDA, Food & Drug Administration
- FEV1, forced expiratory volume in the 1st second
- GINA, Global Initiative for Asthma
- GRADE, Grading of Recommendations Assessment, Development and Evaluation
- ISAR, International Severe Asthma Registry
- OCSs, Oral CorticoSteroids
- Oral corticosteroids
- RW, Real World
- Real-life
- Registr
- SA, severe asthma
- SANI, Severe Asthma Network in Italy
- SARP, Severe Asthma Research Program
- SHARP, Severe Heterogeneous Asthma Research collaboration, Patient-centred
- Severe asthma
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Affiliation(s)
- Giorgio Walter Canonica
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Francesco Blasi
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | - Gianenrico Senna
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanni Passalacqua
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Stefano Aliberti
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
| | | | - Matteo Bonini
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Luisa Brussino
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Caterina Bucca
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Maria F. Caiaffa
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
| | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Gianna Camiciottoli
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
| | - Marco Caminati
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
| | - Giovanna E. Carpagnano
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Cristiano Caruso
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
| | - Stefano Centanni
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
| | - Maria E. Conte
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
| | - Angelo G. Corsico
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
| | - Lorenzo Cosmi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Maria T. Costantino
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
| | - Nunzio Crimi
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
| | - Simona D’Alò
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
| | - Maria D'Amato
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
| | - Stefano Del Giacco
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
| | - Alessandro Farsi
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
| | - Elisabetta Favero
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
| | - Maria P. Foschino Barbaro
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
| | - Giuseppe Guida
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
| | - Manuela Latorre
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
| | | | - Carlo Lombardi
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
| | - Luigi Macchia
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
| | | | - Francesco Menzella
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
| | - Manlio Milanese
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
| | | | - Paolo Montuschi
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Eleonora Nucera
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Roberta Parente
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
| | - Vincenzo Patella
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
| | - Girolamo Pelaia
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
| | - Francesca Puggioni
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
| | - Fabio L.M. Ricciardolo
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
| | - Luca Richeldi
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Italy
| | - Giovanni Rolla
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
| | - Pierachille Santus
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Nicola Scichilone
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
| | - Giuseppe Spadaro
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
| | - Andrea Vianello
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
| | - Vittorio Viviano
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
| | - Mona R. Yacoub
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Maria C. Zappa
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
| | - Enrico Heffler
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
| | - SANI (Severe Asthma Network Italy)
- Personalized Medicine, Asthma & Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele (MI), Italy
- Respiratory Unit and Adult Cystic Fibrosis Center, And Department of Pathophysiology and Transplantation, Fondazione IRCCS Cà Granda, Ospedale Maggiore Policlinico, University of Milan, Italy
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Italy
- Department of Medicine, Allergy Unit Asthma Center, University of Verona, Italy
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa, Italy
- University of Insubria, ICS Maugeri, IRCCS, Varese, Italy
- Respiratory Rehabilitation, ASL3, Genoa, Italy
- Fondazione Policlinico Universitario A. Gemelli, IRCCS Catholic University of Rome, Italy
- Allergy and Clinical Immunology, University of Turin & AO Mauriziano, Turin, Italy
- Respiratory Medicine, Department of Medical Sciences, University of Turin, Italy
- Department of Medical Sciences and Surgery, School and Chair of Allergology and Clinical Immunology, University of Foggia, Italy
- Department of Translational Medical Sciences, University of Campania “L. Vanvitelli”, Naples, Italy
- Deptartment of Experimental and Clinical Biomedical Sciences “Mario Serio”, Respiratory Unit, Careggi University Hospital, Florence, Italy
- Respiratory Medicine Section, Policlinico of Bari, Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari Aldo Moro, Bari, Italy
- Allergy Unit, Fondazione Policlinico A. Gemelli, IRCCS, Rome, Italy
- Department of Health Sciences, University of Milan, Respiratory Unit, ASST Santi Paolo e Carlo, Milan, Italy
- Respiratory Unit, Presidio Ospedaliero of Pordenone, Italy
- Division of Respiratory Diseases, IRCCS Policlinico San Matteo, Foundation and Department of Internal Medicine and Therapeutics, University of Pavia, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Allergy and Clinical Immunology Unit, Department of Medicine, “Carlo Poma” Hospital, Mantova, Italy
- Division of Pneumology and Allergology, Policlinico, University of Catania, Italy
- Allergology Unit, AV3 ASUR Marche, Hospital Civitanova Marche, Macerata, Italy
- Respiratory Department, Division of Respiratory Diseases “Federico II” University, AO Dei Colli, Naples, Italy
- Department of Medical Sciences and Public Health, University of Cagliari, Italy
- SOS of Allergology and Clinical Immunology, Azienda USL Toscana Centro, Prato, Italy
- Severe Asthma Multidisciplinary Outpatient Clinic, Vittorio Veneto Hospital, Treviso, Italy
- Section of Respiratory Diseases, Medical and Surgical Sciences Department, University of Foggia, Italy
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, University of Padua, Italy
- Allergy and Pneumology Unit, A.O. S. Croce & Carle, Cuneo, Italy
- Department of Pneumology, Niguarda Hospital, Milan, Italy
- Departmental Unit of Allergology and Pneumology, Hospital Institute Fondazione Poliambulanza, Brescia, Italy
- Department of Emergency and Organ Transplantation, School and Chair of Allergology and Clinical Immunology, University of Bari Aldo Moro, Bari, Italy
- Pneumology Unit, Santa Maria Nuova Hospital, Azienda USL di Reggio Emilia IRCCS, Italy
- Pulmonology Unit, ASL2 Savonese, Pietra Ligure, Savona, Italy
- UOC Allergology Department, Piacenza, Italy
- Department of Pharmacology, Faculty of Medicine Catholic, University of the Sacred Heart Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Catholic University S. Heart, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
- Department of Medicine, Division of Allergy and Clinical Immunology, University of Salerno, Italy
- Allergology and Clinical Immunology Unit, Department of Medical Science, “Santa Maria Della Speranza” Hospital of Battipaglia, Salerno, Italy
- Department of Medical and Surgical Sciences, Section of Respiratory Diseases, University Magna Graecia, Catanzaro, Italy
- Department of Clinical and Experimental Sciences, University of Brescia, Spedali Civili, Brescia, Italy
- Allergy and Clinical Immunology Unit, University Hospital “G. Martino”, Department of Clinical and Experimental Medicine, University of Messina, Italy
- Department of Clinical and Biological Sciences, University of Turin, San Luigi Hospital, Orbassano, Turin, Italy
- Department of Medicine and Surgery, University of Parma, Italy
- Department of Clinical and Biomedical Sciences, University of Milan, Respiratory Diseases, Sacco University Hospital, ASST Fatebenefratelli-Sacco, Milan, Italy
- Division of Respiratory Diseases, Department of Promoting Health, Maternal-Infant. Excellence and Internal and Specialized Medicine (Promise) G. D'Alessandro, University of Palermo, Palermo, Italy
- Department of Internal Medicine, Clinical Immunology, Clinical Pathology and Infectious Diseases, Azienda Ospedaliera Universitaria Federico II, Naples, Italy
- Division of Respiratory Pathophysiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Italy
- Allergology, Pneumology and Respiratory Department 42 PTA Biondo-Regional Center for Allergy Prevention and Anaphylactic Shock, Palermo, Italy
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Scientific Institute, Milan, Italy
- Pulmonology Department, Sandro Pertini Hospital, Rome, Italy
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22
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Abstract
RATIONALE Whether asthma constitutes a risk factor for coronavirus disease-2019 (COVID-19) is unclear. Here, we aimed to assess whether asthma, the most common chronic disease in children, is associated with higher COVID-19 risk or severity in pediatric populations. METHODS We performed a systematic literature search in three stages: first, we reviewed PubMed, EMBASE, and CINAHL for systematic reviews of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and COVID-19 in pediatric populations, and reviewed their primary articles; second, we searched PubMed for studies on COVID-19 or SARS-CoV-2 and asthma/wheeze, and evaluated whether the resulting studies included pediatric populations; third, we repeated the second search in BioRxiv.org and MedRxiv.org to find pre-prints that may have information on pediatric asthma. RESULTS In the first search, eight systematic reviews were found, of which five were done in pediatric populations; none of the 67 primary studies included data on pediatric asthma as a comorbidity for COVID-19. In the second search, we found 34 results in PubMed, of which five reported asthma in adults, but none included data on children. In the third search, 25 pre-prints in MedRxiv included data on asthma, but none on children. We found one report by the US Centers for Disease Control and Prevention stating that 40/345 (~11.5%) children with data on chronic conditions had "chronic lung diseases including asthma," and one from a tertiary hospital in New York that reported asthma in 11/46 (~23.9%) children hospitalized for COVID-19. CONCLUSION There is scarcely any data on whether childhood asthma (or other pediatric respiratory diseases) constitute risk factors for SARS-CoV-2 infection or COVID-19 severity. Studies are needed that go beyond counting the number of cases in the pediatric age range.
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Affiliation(s)
- Jose A. Castro‐Rodriguez
- Department of Pediatric Pulmonology, Division of PediatricsSchool of Medicine, Pontificia Universidad Católica de ChileSantiagoChile
| | - Erick Forno
- Division of Pulmonary Medicine, Department of PediatricsUniversity of Pittsburgh School of MedicinePittsburghPennsylvania
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23
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FitzGerald JM, Tran TN, Alacqua M, Altraja A, Backer V, Bjermer L, Bjornsdottir U, Bourdin A, Brusselle G, Bulathsinhala L, Busby J, Canonica GW, Carter V, Chaudhry I, Cho YS, Christoff G, Cosio BG, Costello RW, Eleangovan N, Gibson PG, Heaney LG, Heffler E, Hew M, Hosseini N, Iwanaga T, Jackson DJ, Jones R, Koh MS, Le T, Lehtimäki L, Ludviksdottir D, Maitland-van der Zee AH, Menzies-Gow A, Murray RB, Papadopoulos NG, Perez-de-Llano L, Peters M, Pfeffer PE, Popov TA, Porsbjerg CM, Price CA, Rhee CK, Sadatsafavi M, Tohda Y, Wang E, Wechsler ME, Zangrilli J, Price DB. International severe asthma registry (ISAR): protocol for a global registry. BMC Med Res Methodol 2020; 20:212. [PMID: 32819285 PMCID: PMC7439682 DOI: 10.1186/s12874-020-01065-0] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 06/26/2020] [Indexed: 11/10/2022] Open
Abstract
Background Severe asthma exerts a disproportionately heavy burden on patients and health care. Due to the heterogeneity of the severe asthma population, many patients need to be evaluated to understand the clinical features and outcomes of severe asthma in order to facilitate personalised and targeted care. The International Severe Asthma Registry (ISAR) is a multi-country registry project initiated to aid in this endeavour. Methods ISAR is a multi-disciplinary initiative benefitting from the combined experience of the ISAR Steering Committee (ISC; comprising 47 clinicians and researchers across 29 countries, who have a special interest and/or experience in severe asthma management or establishment and maintenance of severe asthma registries) in collaboration with scientists and experts in database management and communication. Patients (≥18 years old) receiving treatment according to the 2018 definitions of the Global Initiative for Asthma (GINA) Step 5 or uncontrolled on GINA Step 4 treatment will be included. Data will be collected on a core set of 95 variables identified using the Delphi method. Participating registries will agree to provide access to and share standardised anonymous patient-level data with ISAR. ISAR is a registered data source on the European Network of Centres for Pharmacoepidemiology and Pharmacovigilance. ISAR’s collaborators include Optimum Patient Care, the Respiratory Effectiveness Group (REG) and AstraZeneca. ISAR is overseen by the ISC, REG, the Anonymised Data Ethics & Protocol Transparency Committee and the ISAR operational committee, ensuring the conduct of ethical, clinically relevant research that brings value to all key stakeholders. Conclusions ISAR aims to offer a rich source of real-life data for scientific research to understand and improve disease burden, treatment patterns and patient outcomes in severe asthma. Furthermore, the registry will provide an international platform for research collaboration in respiratory medicine, with the overarching aim of improving primary and secondary care of adults with severe asthma globally.
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Affiliation(s)
| | | | | | - Alan Altraja
- Department of Pulmonary Medicine, University of Tartu and Lung Clinic, Tartu University Hospital, Tartu, Estonia
| | - Vibeke Backer
- Center of Physical Activity Research, Rigshospitalet and Copenhagen University, Copenhagen, Denmark
| | - Leif Bjermer
- Department of Respiratory Medicine & Allergology, Skåne University Hospital, Lund, Sweden
| | | | - Arnaud Bourdin
- Department of Respiratory Diseases, Montpellier University Hospitals, Hopital Arnaud de Villeneuve and PhyMed Exp (INSERM U 1046, CNRS UMR9214), Universite de Montpellier, Montpellier, France
| | - Guy Brusselle
- Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium.,Departments of Epidemiology and Respiratory Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - John Busby
- Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - Giorgio W Canonica
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy.,SANI-Severe Asthma Network Italy, Milan, Italy
| | | | | | - You Sook Cho
- Division of Allergy, Department of Medicine, Asan Medical Center, College of Medicine, University of Ulsan, Seoul, South Korea
| | - George Christoff
- Faculty of Public Health, Medical University - Sofia, Sofia, Bulgaria
| | - Borja G Cosio
- Son Espases University Hospital-IdISBa-Ciberes, Mallorca, Spain
| | - Richard W Costello
- Clinical Research Centre, Smurfit Building Beaumont Hospital and Department of Respiratory Medicine, RCSI, Dublin, Ireland
| | | | - Peter G Gibson
- Australasian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, Australia.,Department of Respiratory and Sleep Medicine, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, Australia
| | - Liam G Heaney
- Centre for Experimental Medicine, Queen's University Belfast, Belfast, UK
| | - Enrico Heffler
- Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy.,SANI-Severe Asthma Network Italy, Milan, Italy
| | - Mark Hew
- Alfred Health & Monash University, Melbourne, Australia
| | | | - Takashi Iwanaga
- Department of Respiratory Medicine & Allergology, Faculty of Medicine, Kindai University Hospital, Ōsakasayama, Japan
| | - David J Jackson
- Guy's & St Thomas' NHS Trust and King's College London, London, UK
| | - Rupert Jones
- Faculty of Medicine & Dentistry, University of Plymouth, Plymouth, UK
| | - Mariko S Koh
- Department of Respiratory & Critical Care Medicine, Singapore General Hospital and Duke-National University Singapore Medical School, Singapore, Singapore
| | - Thao Le
- Optimum Patient Care, Cambridge, UK
| | - Lauri Lehtimäki
- Allergy Centre, Tampere University Hospital and Tampere University, Tampere, Finland
| | - Dora Ludviksdottir
- Department of Respiratory Medicine, Faculty of Medicine, Landspitali University Hospital and University of Iceland, Reykjavik, Iceland
| | | | | | | | | | | | | | - Paul E Pfeffer
- UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, UK
| | - Todor A Popov
- University Hospital "Sv. Ivan Rilski", Sofia, Bulgaria
| | | | | | - Chin K Rhee
- The Catholic University of Korea, Seoul, South Korea
| | - Mohsen Sadatsafavi
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Yuji Tohda
- Department of Respiratory Medicine & Allergology, Faculty of Medicine, Kindai University Hospital, Ōsakasayama, Japan
| | - Eileen Wang
- Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health and Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Denver and Aurora, CO, USA
| | - Michael E Wechsler
- Division of Pulmonary, Critical Care and Sleep Medicine, Asthma Program, National Jewish Health, Denver, USA
| | | | - David B Price
- Optimum Patient Care, Cambridge, UK. .,Observational and Pragmatic Research Institute, Singapore, Singapore. .,Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
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24
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Ambrose CS, Chipps BE, Moore WC, Soong W, Trevor J, Ledford DK, Carr WW, Lugogo N, Trudo F, Tran TN, Panettieri RA. The CHRONICLE Study of US Adults with Subspecialist-Treated Severe Asthma: Objectives, Design, and Initial Results. Pragmat Obs Res 2020; 11:77-90. [PMID: 32765156 PMCID: PMC7371434 DOI: 10.2147/por.s251120] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Accepted: 05/31/2020] [Indexed: 01/06/2023] Open
Abstract
BACKGROUND Approximately 5-10% of patients with asthma have severe disease. High-quality real-world studies are needed to identify areas for improved management. OBJECTIVE Aligned with the International Severe Asthma Registry, the CHRONICLE study (ClinicalTrials.gov: NCT03373045) was developed to address this need in the US. STUDY DESIGN Learnings from prior studies were applied to develop a real-world, prospective, noninterventional study of US patients with confirmed severe asthma who are treated by subspecialist physicians and require biologic or maintenance systemic immunosuppressant therapy or who are uncontrolled by high-dosage inhaled corticosteroids and additional controllers. Target enrollment is 4000 patients, with patient observation for ≥3 years. A geographically diverse sample of allergist/immunologist and pulmonologist sites approach all eligible patients under their care and report patient characteristics, treatment, and health outcomes every 6 months. Patients complete online surveys every 1-6 months. INITIAL RESULTS From February 2018 to February 2019, 102 sites screened 1428 eligible patients; 936 patients enrolled. Study sites (40% allergist/immunologist, 42% pulmonologist, 18% both) were similar to other US asthma subspecialist samples. Enrolled patients were 67% female with median ages at enrollment and diagnosis of 55 (range: 18-89) and 26 (0-80) years, respectively. Median body mass index was 31 kg/m2; 3% and 29% were current or former smokers, respectively, and >60% reported ≥1 exacerbation in the prior year and suboptimal symptom control. CONCLUSION CHRONICLE will provide high-quality provider- and patient-reported data from a large, real-world cohort of US adults with subspecialist-treated severe asthma.
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Affiliation(s)
| | - Bradley E Chipps
- Capital Allergy & Respiratory Disease Center, Sacramento, CA, USA
| | - Wendy C Moore
- Pulmonary, Critical Care, Allergy, and Immunologic Medicine, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Weily Soong
- Alabama Allergy & Asthma Center, Birmingham, AL, USA
| | - Jennifer Trevor
- Pulmonary, Allergy, & Critical Care Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Dennis K Ledford
- Division of Allergy and Immunology, University of South Florida, Tampa, FL, USA
| | - Warner W Carr
- Allergy & Asthma Associates of Southern California, Mission Viejo, CA, USA
| | - Njira Lugogo
- Pulmonary & Critical Care Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Frank Trudo
- US Medical Affairs, AstraZeneca, Wilmington, DE, USA
| | - Trung N Tran
- Biopharmaceuticals Medical, Respiratory and Immunology, AstraZeneca, Gaithersburg, MD, USA
| | - Reynold A Panettieri
- Institute for Translational Medicine and Science, Rutgers, The State University of New Jersey, New Brunswick, NJ, USA
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25
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FitzGerald JM, Alramezi Y. The Challenges and Opportunities of Maximizing the Benefits of Severe Asthma Registries. J Allergy Clin Immunol Pract 2019; 7:1469-70. [PMID: 31076060 DOI: 10.1016/j.jaip.2018.11.053] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Accepted: 11/16/2018] [Indexed: 11/20/2022]
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26
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Richards LB, van Bragt JJMH, Aarab R, Longo C, Neerincx AH, Sont JK, Weersink EJM, Braunstahl GJ, Brinke AT, Bel EHD, Maitland-van der Zee AH. Treatment Eligibility of Real-Life Mepolizumab-Treated Severe Asthma Patients. J Allergy Clin Immunol Pract 2020; 8:2999-3008.e1. [PMID: 32344189 DOI: 10.1016/j.jaip.2020.04.029] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Revised: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Patients with severe asthma not meeting the strict trial eligibility criteria for mepolizumab are now routinely treated with this biological in clinical practice, but it remains unclear whether these ineligible patients respond differently to mepolizumab treatment. OBJECTIVE This study investigated the extent and reasons for trial ineligibility of real-life, mepolizumab-treated patients with severe asthma and compared the characteristics of these patients with trial populations. Subsequently, therapeutic response in ineligible patients was assessed on the basis of oral corticosteroid (OCS) reduction. METHODS Trial eligibility, population differences, and therapeutic response were assessed using the baseline characteristics of mepolizumab-receiving patients with severe asthma treated in the Amsterdam University Medical Centres and OCS dose at 6 months for OCS-dependent patients extracted from patients' electronic health records. Eligibility criteria and population characteristics from trials investigating mepolizumab were extracted from their original publications. RESULTS A total of 82.4% of 119 mepolizumab-receiving, real-life patients with severe asthma were ineligible for trial inclusion, wherein 42.9% and 39.5% were excluded on the basis of inclusion and exclusion criteria, respectively. The clinical care population was older, more often male and demonstrating a better lung function under lower OCS maintenance dosages in comparison with trial populations. A total of 50% of 66 ineligible, OCS-dependent mepolizumab-treated patients were able to reduce their maintenance OCS dosage to ≤5 mg prednisone/day. CONCLUSIONS A large proportion of the real-life, mepolizumab-treated population with severe asthma would be excluded from trial participation, and significant differences in population characteristics exist. Regardless, a large fraction of ineligible patients in clinical care can reduce maintenance OCS dosage under mepolizumab therapy.
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Affiliation(s)
- Levi B Richards
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands.
| | - Job J M H van Bragt
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Reim Aarab
- Department of Pulmonary Medicine, OLVG Hospital, Amsterdam, the Netherlands
| | - Cristina Longo
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Anne H Neerincx
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Jaap K Sont
- Department of Biomedical Data Sciences, Section Medical Decision Making, Leiden University Medical Centre, Leiden, the Netherlands
| | - Els J M Weersink
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Gert-Jan Braunstahl
- Department of Pulmonology, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Anneke Ten Brinke
- Department of Respiratory Medicine, Medical Centre Leeuwarden, Leeuwarden, the Netherlands
| | - Elisabeth H D Bel
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
| | - Anke-Hilse Maitland-van der Zee
- Department of Respiratory Medicine, Amsterdam University Medical Centres, (Amsterdam UMC), University of Amsterdam, Amsterdam, the Netherlands
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27
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Siddiqui S, Denlinger LC, Fowler SJ, Akuthota P, Shaw DE, Heaney LG, Brown L, Castro M, Winders TA, Kraft M, Wagers S, Peters MC, Pavord ID, Walker S, Jarjour NN. Unmet Needs in Severe Asthma Subtyping and Precision Medicine Trials. Bridging Clinical and Patient Perspectives. Am J Respir Crit Care Med 2020; 199:823-829. [PMID: 30726120 DOI: 10.1164/rccm.201809-1817pp] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Affiliation(s)
- Salman Siddiqui
- 1 National Institute for Health Research (NIHR) Respiratory Biomedical Research Centre, College of Life Sciences, University of Leicester, Leicester, United Kingdom
| | - Loren C Denlinger
- 2 Allergy, Pulmonary, and Critical Care Division, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
| | - Stephen J Fowler
- 3 Division of Infection, Immunity, and Respiratory Medicine, School of Biological Sciences, The University of Manchester and NIHR Biomedical Research Centre, Manchester University National Health Service Foundation Trust, Manchester, United Kingdom
| | - Praveen Akuthota
- 4 Pulmonary Division, Department of Medicine, University of California-San Diego, La Jolla, California
| | - Dominick E Shaw
- 5 NIHR Biomedical Research Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, United Kingdom
| | - Liam G Heaney
- 6 Centre for Experimental Medicine, Queens University Belfast, Belfast, United Kingdom
| | - Louise Brown
- 7 Medical Research Council Clinical Trials Unit at University College London, Institute of Clinical Trials and Methodology, London, United Kingdom
| | - Mario Castro
- 8 Division of Pulmonary and Critical Care Medicine, Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
| | - Tonya A Winders
- 9 Allergy and Asthma Network, Global Allergy and Asthma Patient Platform, Vienna, Austria
| | - Monica Kraft
- 10 Department of Medicine, University of Arizona College of Medicine, Tucson, Arizona
| | | | - Michael C Peters
- 12 Division of Pulmonary and Critical Care Medicine, Department of Medicine and the Cardiovascular Research Institute, University of California San Francisco, San Francisco, California
| | - Ian D Pavord
- 13 Respiratory Medicine Unit, Nuffield Department of Medicine, University of Oxford, Oxford, United Kingdom; and
| | - Samantha Walker
- 14 Asthma UK and Edinburgh University, Edinburgh, United Kingdom
| | - Nizar N Jarjour
- 2 Allergy, Pulmonary, and Critical Care Division, Department of Medicine, University of Wisconsin-Madison, Madison, Wisconsin
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28
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Gibson PG, Yang IA, Upham JW, Reynolds PN, Hodge S, James AL, Jenkins C, Peters MJ, Marks GB, Baraket M, Powell H, Simpson JL. Efficacy of azithromycin in severe asthma from the AMAZES randomised trial. ERJ Open Res 2019; 5:00056-2019. [PMID: 31886156 PMCID: PMC6926362 DOI: 10.1183/23120541.00056-2019] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 07/09/2019] [Indexed: 12/12/2022] Open
Abstract
Background Low-dose azithromycin is an effective therapy for persistent asthma; however, its benefit in severe asthma is not defined. Methods Participants with severe asthma were identified from the AMAZES randomised, placebo-controlled trial of long-term (48 weeks) low-dose azithromycin. Participants who met one of the following severe asthma definitions were included: 1) Global Initiative for Asthma step 4 treatment with poor asthma control (asthma control questionnaire score ≥0.75); 2) International Severe Asthma Registry definition; 3) American Thoracic Society and European Respiratory Society severe asthma definitions. The rate of total exacerbations was calculated for each subgroup and efficacy of azithromycin compared with placebo. Asthma-related quality of life was assessed before and after treatment along with adverse effects. Results Azithromycin significantly reduced asthma exacerbations in each group. In patients meeting the American Thoracic Society and European Respiratory Society task force definition of severe asthma (n=211), the rate of exacerbations with treatment was 1.2 per person-year, which was significantly less than for placebo (2.01 per person-year), giving an incidence rate ratio (95% CI) of 0.63 (0.41, 0.96). The proportion of participants experiencing at least one asthma exacerbation was reduced by azithromycin from 64% to 49% (p=0.021). A similar beneficial treatment effect was seen in participants poorly controlled with Global Initiative for Asthma step 4 treatment and those with International Severe Asthma Registry-defined severe asthma. Azithromycin also significantly improved the quality of life in severe asthma (p<0.05). Treatment was well tolerated, with gastrointestinal symptoms being the main adverse effect. Conclusion Long-term, low-dose azithromycin reduced asthma exacerbations and improved the quality of life in patients with severe asthma, regardless of how this was defined. These data support the addition of azithromycin as a treatment option for patients with severe asthma. Low-dose azithromycin is effective therapy for persistent asthma. AMAZES supports AZM as a treatment option for patients with severe asthma. Long-term, low-dose AZM reduces asthma exacerbations and improves quality of life in patients with severe asthma.http://bit.ly/2LWyjYz
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Affiliation(s)
- Peter G Gibson
- Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia.,Woolcock Institute of Medical Research, Glebe, Australia
| | - Ian A Yang
- Faculty of Medicine, The University of Queensland, St Lucia, Australia.,Dept of Thoracic Medicine, The Prince Charles Hospital, Chermside, Australia
| | - John W Upham
- Faculty of Medicine, The University of Queensland, St Lucia, Australia.,Dept of Respiratory Medicine, Princess Alexandra Hospital, Woolloongabba, Australia
| | - Paul N Reynolds
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia
| | - Sandra Hodge
- Dept of Thoracic Medicine, Royal Adelaide Hospital, Adelaide, Australia.,Dept of Medicine, The University of Adelaide, Adelaide, Australia
| | - Alan L James
- Dept of Pulmonary Physiology and Sleep Medicine, Sir Charles Gairdner Hospital, Nedlands, Australia.,School of Medicine and Pharmacology, The University of Western Australia, Perth, Australia
| | - Christine Jenkins
- Respiratory Trials, The George Institute for Global Health, Sydney, Australia.,Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, Australia
| | - Matthew J Peters
- Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, Australia.,Dept of Thoracic Medicine, Concord General Hospital, Concord, Australia
| | - Guy B Marks
- Woolcock Institute of Medical Research, Glebe, Australia.,South Western Sydney Clinical School, UNSW, Sydney, Australia
| | - Melissa Baraket
- Respiratory Medicine Dept and Ingham Institute Liverpool Hospital, University of New South Wales Medicine Faculty, Sydney, Australia
| | - Heather Powell
- Dept of Respiratory and Sleep Medicine, Hunter Medical Research Institute, Newcastle, Australia.,Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
| | - Jodie L Simpson
- Priority Research Centre for Healthy Lungs, The University of Newcastle, Newcastle, Australia
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International Severe Asthma Registry: Mission Statement. Chest 2019; 157:805-814. [PMID: 31838187 DOI: 10.1016/j.chest.2019.10.051] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 08/23/2019] [Accepted: 10/04/2019] [Indexed: 12/15/2022] Open
Abstract
Regional and/or national severe asthma registries provide valuable country-specific information. However, they are often limited in scope within the broader definitions of severe asthma, have insufficient statistical power to answer many research questions, lack intraoperability to share lessons learned, and have fundamental differences in data collected, making cross comparisons difficult. What is missing is a worldwide registry which brings all severe asthma data together in a cohesive way, under a single umbrella, based on standardized data collection protocols, permitting data to be shared seamlessly. The International Severe Asthma Registry (ISAR; http://isaregistries.org/) is the first global adult severe asthma registry. It is a joint initiative where national registries (both newly created and preexisting) retain ownership of their own data but open their borders and share data with ISAR for ethically approved research purposes. Its strength comes from collection of patient-level, anonymous, longitudinal, real-life, standardized, high-quality data (using a core set of variables) from countries across the world, combined with organizational structure, database experience, inclusivity/openness, and clinical, academic, and database expertise. This gives ISAR sufficient statistical power to answer important research questions, sufficient data standardization to compare across countries and regions, and the structure and expertise necessary to ensure its continuance and the scientific integrity and clinical applicability of its research. ISAR offers a unique opportunity to implement existing knowledge, generate new knowledge, and identify the unknown, therefore promoting new research. The aim of this commentary is to fully describe how ISAR may improve our understanding of severe asthma.
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Heffler E, Paoletti G, Giorgis V, Puggioni F, Racca F, Del Giacco S, Bagnasco D, Caruso C, Brussino L, Rolla G, Canonica GW. Real-life studies of biologics used in asthma patients: key differences and similarities to trials. Expert Rev Clin Immunol 2019; 15:951-958. [PMID: 31389304 DOI: 10.1080/1744666x.2019.1653758] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Introduction: The precision medicine approach that is now mandatory for severe asthma management includes the use of novel biologic agents blocking specific immunological mechanisms that are responsible for disease phenotypes and endotypes: monoclonal antibodies blocking IgE, IL-5 and IL-4/IL-13 immunological pathways are so far available. Areas covered: Clinical trials involving a large number of patients proved their efficacy in reducing asthma exacerbations, improving lung function and quality of life, and reducing the need for systemic corticosteroid treatment. Since biologics have been available for routine use, a series of real-life experiences on severe asthmatics treated with them have been published: these studies confirmed the beneficial effects in a real-world setting (effectiveness) of these drugs and showed novel aspects that were not covered by clinical trials, such as their effect on particular subgroup of patients, unexpected adverse events, and potential novel indications. Expert opinion: Both clinical trials and real-life experiences are needed to establish robust data on biologic agents for severe asthma, with real-life studies giving more broader insights on different aspects related to the biologics themselves and to the disease.
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Affiliation(s)
- Enrico Heffler
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Veronica Giorgis
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Francesca Puggioni
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Francesca Racca
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
| | - Stefano Del Giacco
- Department of Medical Sciences "M. Aresu", University of Cagliari , Cagliari , Italy
| | - Diego Bagnasco
- Allergy and Respiratory Diseases, IRCCS Policlinico San Martino, University of Genoa , Genoa , Italy
| | - Cristiano Caruso
- Allergy Unit - Fondazione Policlinico "A. Gemelli" - IRCSS , Rome , Italy
| | - Luisa Brussino
- Department of Medical Science, University of Torino & Allergy and Clinical Immunology Unit, AO Ordine Mauriziano "Umberto I" , Torino , Italy
| | - Giovanni Rolla
- Department of Medical Science, University of Torino & Allergy and Clinical Immunology Unit, AO Ordine Mauriziano "Umberto I" , Torino , Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy.,Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS , Rozzano , Italy
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Dharmage SC, Bui DS, Perret J, Lowe A, Lodge C. A step in the right direction: Harmonizing measures for use in asthma patient registries. J Allergy Clin Immunol 2019; 144:663-664. [PMID: 31325460 DOI: 10.1016/j.jaci.2019.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 07/01/2019] [Accepted: 07/09/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Shyamali Chandrika Dharmage
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia.
| | - Dinh Son Bui
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Department of Toxicology, Hanoi University of Pharmacy, Hanoi, Vietnam
| | - Jennifer Perret
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Institute for Breathing & Sleep (IBAS), Heidelberg, Melbourne, Australia
| | - Adrian Lowe
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia
| | - Caroline Lodge
- Allergy and Lung Health Unit, University of Melbourne, Melbourne, Australia; Murdoch Childrens Research Institute, Melbourne, Australia
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Denton E, Hore-Lacy F, Radhakrishna N, Gilbert A, Tay T, Lee J, Dabscheck E, Harvey ES, Bulathsinhala L, Fingleton J, Price D, Gibson PG, O'Hehir R, Hew M. Severe Asthma Global Evaluation (SAGE): An Electronic Platform for Severe Asthma. J Allergy Clin Immunol Pract 2019; 7:1440-9. [PMID: 30954467 DOI: 10.1016/j.jaip.2019.02.042] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 12/16/2018] [Revised: 02/22/2019] [Accepted: 02/27/2019] [Indexed: 01/26/2023]
Abstract
Severe asthma is complex and heterogeneous; ad hoc outpatient assessment can be suboptimal. Systematic evaluation improves outcomes and is recommended by international guidelines. Electronic templates improve physician performance and clinical processes, and may be useful in severe asthma systematic evaluation. We developed the Severe Asthma Global Evaluation (SAGE) electronic platform to streamline this process, via Research Electronic Data Capture (REDCap). It incorporates: a questionnaire battery for patient completion before clinical consultation; asthma and comorbidity modules; a clinical summary page in an asthma management module; a nurse educator module; a structured panel discussion record; and an automatically generated report incorporating all key data. SAGE incorporates 282 clinician input fields, with a typical consultation requiring completion of 169. To streamline the process SAGE contains 34 autocalculations and 20 decision support tools. It incorporates all 95 core variables of the International Severe Asthma Registry, with which it is directly compatible. SAGE improves symptom control and exacerbations in patients with difficult asthma. In conclusion, we developed and validated an electronic platform that facilitates a comprehensive but streamlined systematic evaluation of severe asthma that is available for free download via REDCap. Its use enhances management of patients with severe asthma and facilitates audit and international research collaboration.
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Abstract
Asthma is a heterogeneous disease comprising of multiple phenotypes and affects patients from childhood up to old age. In this review, we summarize the current knowledge on the similarities and differences in asthma across different age-groups, with emphasis on the perspective from primary care. Despite the similar disease presentation, phenotyping studies showed that there are differences in the distribution of phenotypes of asthma presenting in childhood compared to that in adulthood. Whereas, asthma with early age of onset tends to be of the atopic phenotype, the disease shifts toward the non-atopic phenotypes at later ages. Studies within primary care patients aiming to elucidate risk factors for future asthma exacerbation have shown pediatric and elderly patients to be at higher risk for future asthma attacks compared to other adult patients. Regardless, both pediatric and adult studies demonstrated previous asthma episodes and severity, along with high blood eosinophil to predict subsequent asthma attacks. Differences in childhood and adult asthma are not limited to the underlying phenotypes but also extends to the challenges in the diagnosis, treatment, and management of the disease. Diagnosis of asthma is complicated by age-specific differential diagnoses such as infectious wheezing and nasal obstruction in children, and aging-related problems such as heart disease and obesity in the elderly. There are also age-related issues leading to decreased disease control such as non-adherence, tobacco use, difficulty in using inhalers and corticosteroid-related side effects which hinder asthma control at different patient age-groups. Several clinical guidelines are available to guide the diagnosis and drug prescription of asthma in pediatric patients. However, there are conflicting recommendations for the diagnostic tools and treatment for pediatric patients, posing additional challenges for primary care physicians in working with multiple guidelines. While tools such as spirometry and peak flow variability are often available in primary care, their usage in preschool patients is not consistently recommended. FeNO measurement may be a valuable non-invasive tool which can be adopted by primary physicians to assist asthma diagnosis in preschool-age patients.
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Affiliation(s)
- Alan Kaplan
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Antony Hardjojo
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - Shaylynn Yu
- Observational and Pragmatic Research Institute, Singapore, Singapore
| | - David Price
- Observational and Pragmatic Research Institute, Singapore, Singapore.,Division of Applied Health Sciences, Centre of Academic Primary Care, University of Aberdeen, Aberdeen, United Kingdom.,Optimum Patient Care, Cambridge, United Kingdom
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Heffler E, Canonica GW, Diamant Z, Fonseca J, Malinovschi A. Personalized Approach to Severe Asthma. Biomed Res Int 2018; 2018:2465172. [PMID: 30671448 DOI: 10.1155/2018/2465172] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/18/2018] [Accepted: 11/18/2018] [Indexed: 01/29/2023]
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