1
|
Latorre M, Rizzi A, Paggiaro P, Baiardini I, Bagnasco D, DelGiacco S, Lombardi C, Patella V, Nucera E, Parente R, Paoletti G, Pini L, Ridolo E, Senna G, Blasi F, Canonica GW, Aruanno A, Ballacchino C, Bonavia M, Calabrese C, Caminati M, Carbonara M, Cardini C, Caruso C, Cattani L, Crivellaro MA, Diana A, Durante E, Favero E, Barbaro MPF, Frateiacci S, Guarnieri G, Lofaro A, Losa F, Magarò N, Menzella F, Ricciardi L, Scioscia G, Testino E, Torracca F. Asthma management, focused on the use of oral corticosteroids: the opinions of Italian asthmatic patients. J Asthma 2024:1-26. [PMID: 38578082 DOI: 10.1080/02770903.2024.2338863] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/31/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Patients' perceptions of asthma symptoms, and attitudes regarding diagnosis and management, can affect their ability to reach good asthma control. The aim of the study was to explore patients' perceptions of asthma management, with focus on treatment with oral corticosteroids (OCS). METHODS A DOXAPHARMA survey was conducted. A questionnaire with 46 multiple choice questions was completed by 50 patients with severe uncontrolled asthma, and 258 with mild-moderate controlled or partly controlled asthma. Participants were representative of Italian asthmatic patients-with medium age, long asthma duration, delayed diagnosis, poor asthma control, and frequent exacerbations. RESULTS Many asthmatics reported inadequate pharmacologic treatment. The majority but not all patients regularly used ICS/LABA. Oral treatment was common, mainly with OCS, particularly in severe asthmatics. One-fourth of patients did not regularly use inhaled therapy, and adherence was poor, resulting in frequent OCS use to treat exacerbations, which were common in mild-moderate cases. Patients were fairly satisfied with asthma therapies, but many had concerns about long-term corticosteroid use. Patients complained about poor management of comorbidities associated with asthma and OCS use, but were generally satisfied with their patient/doctor relationships. Many patients failed to achieve optimal health-related quality of life (HRQoL), mainly those with severe asthma who used OCS treatment and emphasized how OCS therapy impacted QoL. CONCLUSIONS The survey results confirmed many problems related to mild-moderate and severe asthma management in Italy and highlighted the overuse of OCS rather than more effective and safe treatments, which had strong negative effects on HRQoL.
Collapse
Affiliation(s)
- Manuela Latorre
- Pulmonology Unit, Department of Medical Specialties, Nuovo Ospedale Apuano, Massa, Italy
| | - Angela Rizzi
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
| | - Pierluigi Paggiaro
- Department of Surgery, Medicine, Molecular Biology and Critical Care, University of Pisa, Pisa, Italy
| | - Ilaria Baiardini
- Respiratory Clinic, Department of Internal Medicine, University of Genoa, Genoa, Italy
| | - Diego Bagnasco
- Clinica delle Malattie Respiratorie ed Allergologia, IRCCS Policlinico San Martino, Genova, Italy
- Dipartimento di Medicina Interna (DIMI), Università degli Studi di Genova, Italy
| | - Stefano DelGiacco
- Unit of Allergy and Clinical Immunology, Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | - Carlo Lombardi
- Departmental Unit of Allergology & Respiratory Diseases Fondazione Poliambulanza Brescia, Italy
| | - Vincenzo Patella
- Department of Internal and Respiratory Medicine, Division of Allergy and Clinical Immunology, "Santa Maria della Speranza" Hospital, Salerno, Italy
| | - Eleonora Nucera
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
- Medicina e Chirurgia Traslazionale, Università Cattolica del Sacro Cuore, 00168 Rome, Italy
| | - Roberta Parente
- Division of Allergy and Clinical Immunology, Department of Medicine, University of Salerno, Italy
| | - Giovanni Paoletti
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Laura Pini
- Department of Clinical and Experimental Sciences, Spedali Civili di Brescia, University of Brescia, Italy
| | - Erminia Ridolo
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | - Gianenrico Senna
- Asthma Center and Allergy Unit, University of Verona and General Hospital, Verona, Italy
| | - Francesco Blasi
- Internal Medicine Department, Respiratory Unit and Cystic Fibrosis Center, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico di Milano, Milan, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Giorgio Walter Canonica
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Personalized Medicine, Asthma and Allergy, Humanitas Clinical and Research Center, IRCCS, Rozzano, Italy
| | - Arianna Aruanno
- UOSD Allergologia e Immunologia Clinica, Dipartimento Scienze Mediche e Chirurgiche addominali ed endocrino metaboliche, Roma, Italy
| | | | | | - Cecilia Calabrese
- Department of Translational Medical Sciences, University of Campania "L. Vanvitelli", Naples, Italy
| | - Marco Caminati
- Department of Medicine, Asthma, Allergy and Clinical Immunology Section, University of Verona, Verona, Italy
| | | | - Cristina Cardini
- Fondazione della Salute Respiratoria della Società Itaiana di Pneumologia SIP-IRS (via San Gregorio 12, 20124, Milano) Milan, Italy
| | - Cristiano Caruso
- UOSD DH INTERNAL MEDICINE AND DIGESTIVE DISEASE, Fondazione Policlinico A. Gemelli, IRCCS Rome Italy
| | - Luciano Cattani
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
- AsmaGrave OdV
| | - Maria Angiola Crivellaro
- Occupational Health Unit and Allergology Padova University Hospital, Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Padova, Italy
| | - Alessandra Diana
- APACS APS - Associazione Pazienti della Sindrome di Churg Strauss
| | - Eugenia Durante
- APACS APS - Associazione Pazienti della Sindrome di Churg Strauss
| | - Elisabetta Favero
- Centro Allergologico e Malattie Rare, Dipartimento di Medicina Ospedale Ca' Foncello, Treviso, Italy
| | | | - Sandra Frateiacci
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
- ALAMA APS - Associazione Liberi dall'Asma, dalle Malattie Allergiche, Atopiche, Respiratorie e Rare
| | - Gabriella Guarnieri
- Department of Cardiac-Thoracic-Vascular Sciences and Public Health, Respiratory Pathophysiology Unit, University of Padova, Padova, Italy
| | - Alessia Lofaro
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
| | - Francesca Losa
- UO di Allergologia, Immunologia clinica e Reumatologia, Ospedale Carlo Poma, ASST Mantova, Italy
| | - Nadia Magarò
- FederASMA e ALLERGIE OdV - Federazione Italiana Pazienti
| | - Francesco Menzella
- Pulmonology Unit, S. Valentino Hospital, AULSS 2 Marca Trevigiana, Montebelluna, Treviso, Italy
| | - Luisa Ricciardi
- Allergy and Clinical Immunology Unit, A.O.U. Policlinico "G. Martino"; Department of Clinical and Experimental Medicine, University of Messina, Messina, Italy
| | - Giulia Scioscia
- Department of Medical and Surgical Sciences, University of Foggia, Italy
| | - Elisa Testino
- Clinica delle Malattie Respiratorie ed Allergologia, IRCCS Policlinico San Martino, Genova, Italy
| | | |
Collapse
|
2
|
Lanario JW, Cartwright L, Jones RC, Sayers R, Hyland ME, Masoli M. "Life-changing": the experience of super-responders to biologics in severe asthma. BMC Pulm Med 2022; 22:445. [PMID: 36437459 PMCID: PMC9702657 DOI: 10.1186/s12890-022-02241-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 11/14/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND There is limited information on the patient's perspective of how biologic treatments impact their lives. We conducted a qualitative study to explore the patient's experience of being considered a super-responder from a quality of life perspective. METHODS Patients with severe asthma identified as super-responders were invited to semi-structured interviews conducted online. Participants could bring a family member/friend to the interview. The interviews explored experiences of biologic treatment, were transcribed and underwent thematic analysis. RESULTS Twenty-five participants took part in this study. Themes emerged on the impact of biologic treatment for participants and for their friends/family: (i) Words used to describe their often life-changing experiences and (ii) the positive changes noted. Biologic treatment stopped the disruption of family life and social life caused by exacerbations. Improvements in mental health were also noted. Marked individual variations in the way it affected their lives were noted. Most participants noticed improvements 2-3 months after starting their biologic, but some noticed improvement within a few days and others after 6 months. CONCLUSIONS Super-responders reported profound but heterogeneous improvements following biologic treatment beyond asthma symptoms and exacerbations including important benefits to social and family life. Improvements may be underestimated as social and family benefits are not reliably measured in current studies with implications for health economic evaluations. Not all patients are super-responders, and excellent responses may be lost in group mean data in trials. Individual time course and response patterns need further elucidation to identify who will respond best to biologics.
Collapse
Affiliation(s)
- Joseph W Lanario
- Faculty of Health, University of Plymouth, Room N10, ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.
| | - Lucy Cartwright
- Faculty of Health, University of Plymouth, Room N10, ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK
| | | | - Ross Sayers
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, University of Exeter, Exeter, UK
| | - Michael E Hyland
- Faculty of Health, University of Plymouth, Room N10, ITTC Building, Plymouth Science Park, Plymouth, Devon, PL6 8BX, UK.,Plymouth Marjon University, Plymouth, UK
| | - Matthew Masoli
- Department of Respiratory Medicine, Royal Devon and Exeter Hospital, University of Exeter, Exeter, UK.,Royal Devon and Exeter Hospital, University of Exeter, Exeter, UK
| |
Collapse
|
3
|
Oh BC, Lee JE, Nam JH, Hong JY, Kwon SH, Lee EK. Health-related quality of life in adult patients with asthma according to asthma control and severity: A systematic review and meta-analysis. Front Pharmacol 2022; 13:908837. [DOI: 10.3389/fphar.2022.908837] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 10/28/2022] [Indexed: 11/22/2022] Open
Abstract
Background: The utility values are increasingly being used in economic evaluations and health policy decision making. This study aims to conduct a systematic literature review and meta-analysis of the utility values for asthma, particularly with respect to severity and asthma control.Materials and methods: A literature search was conducted using the MEDLINE, Embase, and Cochrane Central Register of Controlled Trials databases for studies published until July, 2020, reporting the utilities of adult asthma. We extracted utility values derived by nine indirect and four direct utility instruments. Meta-analyses were performed for each utility instrument according to health states based on the level of asthma control and severity.Results: Fifty-two eligible studies were included in our systematic review, of which forty studies were used in the meta-analyses. Among the 13 utility instruments, the most used was EQ-5D-3L, whereas EQ-5D-5L showed the narrowest 95% confidence interval (95% CI, 0.83–0.86) of pooled utility. The pooled utility of asthma declined with worsening control levels and severity. The pooled utility value of EQ-5D-3L was 0.72 (95% CI, 0.63–0.80) for uncontrolled, 0.82 (95% CI, 0.75–0.88) for partly controlled, and 0.87 (95% CI, 0.84–0.90) for well-controlled asthma.Conclusion: Our study shows that EQ-5D-3L and EQ-5D-5L are appropriate for economic evaluations in terms of availability and variability of information, respectively. Asthma patients had poorer utility values with worsened severity and level of asthma control. This study will be useful for health economists conducting economic evaluations of asthma treatments.
Collapse
|
4
|
Lanario JW, Hyland ME, Menzies-Gow A, Mansur AH, Dodd JW, Fowler SJ, Jones RC, Masoli M. Validation of subscales of the Severe Asthma Questionnaire (SAQ) using exploratory factor analysis (EFA). Health Qual Life Outcomes 2020; 18:336. [PMID: 33036615 PMCID: PMC7547484 DOI: 10.1186/s12955-020-01593-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 10/05/2020] [Indexed: 01/02/2023] Open
Abstract
Background The Severe Asthma Questionnaire (SAQ) is a health related quality of life (HRQoL) questionnaire validated for use in severe asthma. It is scored using the mean value of 16 items (SAQ score) in addition to a single item global rating of HRQoL (SAQ-global). The aim was to validate clinically relevant subscales using exploratory factor analysis (EFA). Methods The SAQ was completed, along with measures of asthma control and EQ5D-5L by patients attending six UK severe asthma centres. Clinical data were included in the analysis. EFA using principal axis factoring and oblimin rotation was used to achieve simple structure of data. Results 460 patients with severe asthma participated, 65% women, mean age 51 (16–83) years. A three factor solution achieved best fit and showed that the SAQ items formed three distinct but inter-correlated groups of items where items were grouped in a way that was consistent with item content. The three subscales were differentially associated with clinically relevant variables (lung function and mood). Males and females interpreted the question of night disturbance in different ways. Conclusions This paper provides a template for best practice in the use of EFA when validating HRQoL subscales. The SAQ can be scored as three subscales with content reflecting three different constructs people with severe asthma use when making judgements about their lives. The subscale ‘My Life’ assesses the impact of severe asthma on different life activities, ‘My Mind’ assesses the perceived emotional impact and ‘My Body’ the impact of extra-pulmonary symptoms and side effects.
Collapse
Affiliation(s)
| | - Michael E Hyland
- University of Plymouth, Plymouth, UK. .,Plymouth Marjon University, Plymouth, UK.
| | | | - Adel H Mansur
- Heartlands Hospital, University Hospitals Birmingham, University of Birmingham, Birmingham, UK
| | - James W Dodd
- Academic Respiratory Unit, Southmead Hospital, North Bristol Hospital Trust, Bristol, UK
| | - Stephen J Fowler
- School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Manchester Academic Health Science Centre and NIHR Manchester Biomedical Research Centre, Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | | | - Matthew Masoli
- Royal Devon and Exeter Hospital, University of Exeter, Exeter, UK
| |
Collapse
|