Background

Approximately 30% to 50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid (ICS)/long-acting β₂-agonist (LABA) therapy. Data on prevalence and burden of uncontrolled asthma in specialty settings are lacking.

Objective

To evaluate the prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the United States.

Methods

Adults with physician-diagnosed asthma attending pulmonary and allergy clinics with self-reported ICS use in the previous 4 weeks completed an electronic questionnaire including the Asthma Control Test and St George’s Respiratory Questionnaire. Additional information was collected using an electronic case report form.

Results

Of 774 patients attending 12 pulmonary and 12 allergy clinics, 53% were not well controlled (mean [SD] Asthma Control Test, 14.3 [3.6] vs 22.4 [1.6] in well-controlled patients). Among ICS/LABA users, 56% were not well controlled, which increased with increasing ICS dose (low-dose 45.7%; high-dose 59.7%). The not well-controlled group reported more respiratory illnesses, more comorbidities, and poorer health-related quality of life (mean [SD] St George’s Respiratory Questionnaire, 46.1 [18.9] vs 19.8 [12.9] in the well-controlled group). These patients also had more asthma exacerbations (≥1 exacerbation, 68.9% vs 43.1%) and increased health care resource utilization (≥1 asthma-related hospitalization, 10.7% vs 2.7%); 27.3% were also receiving systemic corticosteroids. Approximately 40% of the population were eligible for step-up to ICS/LABA/long-acting muscarinic antagonist triple therapy, and 20% were eligible for biologic therapy.

Conclusion

Substantial unmet needs exist among patients with inadequately controlled asthma managed in United States specialist settings, which may be addressed by improved patient and physician education, better guideline implementation, and improved adherence.

中文翻译：

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真实证据

背景

大约有30％〜50％的患者有中度/重度哮喘已经充分控制疾病，尽管坚持吸入糖皮质激素（ICS）/长效β ₂激动剂（LABA）治疗。缺乏有关专业环境中不受控制的哮喘患病率和负担的数据。

客观的

在美国的呼吸专科诊所评估未控制哮喘的患病率和负担。

方法

在过去4周内就诊并自行报告ICS的就诊于肺和过敏诊所的经医生诊断为哮喘的成人填写了电子问卷，其中包括哮喘控制测试和圣乔治呼吸问卷。使用电子病例报告表收集了更多信息。

结果

在12家肺病诊所和12​​家过敏诊所的774例患者中，有53％的患者未得到良好控制（平均[SD]哮喘控制测试，控制良好的患者为14.3 [3.6] vs 22.4 [1.6]）。在ICS / LABA用户中，有56％的人没有得到很好的控制，并且随着ICS剂量的增加而增加（低剂量45.7％；高剂量59.7％）。未得到很好控制的组报告了更多的呼吸系统疾病，更多的合并症和与健康有关的较差的生活质量（在[良好]对照组中，平均[SD]圣乔治呼吸调查问卷，分别为46.1 [18.9]和19.8 [12.9]）。这些患者的哮喘急性发作也更多（≥1急性发作，分别为68.9％和43.1％）和医疗资源利用率的提高（≥1与哮喘相关的住院，分别为10.7％和2.7％）；27.3％的人也接受全身性皮质类固醇激素治疗。

结论

在美国专科机构管理的哮喘控制不佳的患者中，存在大量未满足的需求，这可以通过改善患者和医师的教育水平，更好地实施指南和提高依从性来解决。