Characterization of Severe Asthma Worldwide: Data From the International Severe Asthma Registry

Eileen Wang; Michael E Wechsler; Trung N Tran; Liam G Heaney; Rupert C Jones; Andrew N Menzies-Gow; John Busby; David J Jackson; Paul E Pfeffer; Chin Kook Rhee; You Sook Cho; G Walter Canonica; Enrico Heffler; Peter G Gibson; Mark Hew; Matthew Peters; Erin S Harvey; Marianna Alacqua; James Zangrilli; Lakmini Bulathsinhala; Victoria A Carter; Isha Chaudhry; Neva Eleangovan; Naeimeh Hosseini; Ruth B Murray; David B Price

doi:10.1016/j.chest.2019.10.053

Characterization of Severe Asthma Worldwide: Data From the International Severe Asthma Registry

Chest. 2020 Apr;157(4):790-804. doi: 10.1016/j.chest.2019.10.053. Epub 2019 Nov 27.

Authors

Eileen Wang¹, Michael E Wechsler², Trung N Tran³, Liam G Heaney⁴, Rupert C Jones⁵, Andrew N Menzies-Gow⁶, John Busby⁴, David J Jackson⁷, Paul E Pfeffer⁸, Chin Kook Rhee⁹, You Sook Cho¹⁰, G Walter Canonica¹¹, Enrico Heffler¹¹, Peter G Gibson¹², Mark Hew¹³, Matthew Peters¹⁴, Erin S Harvey¹⁵, Marianna Alacqua¹⁶, James Zangrilli³, Lakmini Bulathsinhala¹⁷, Victoria A Carter¹⁷, Isha Chaudhry¹⁷, Neva Eleangovan¹⁷, Naeimeh Hosseini¹⁷, Ruth B Murray¹⁷, David B Price¹⁸

Affiliations

¹ Division of Allergy & Clinical Immunology, Department of Medicine, National Jewish Health, Denver, CO, and Division of Allergy & Clinical Immunology, Department of Internal Medicine, University of Colorado Hospital, Aurora, CO.
² NJH Cohen Family Asthma Institute, Department of Medicine, National Jewish Health, Denver, CO.
³ AstraZeneca, Gaithersburg, MD.
⁴ UK Severe Asthma Network and National Registry, Queen's University Belfast, Belfast, Northern Ireland.
⁵ Faculty of Medicine and Dentistry, University of Plymouth, Plymouth, United Kingdom.
⁶ UK Severe Asthma Network and National Registry, Royal Brompton & Harefield NHS Foundation Trust, London, United Kingdom.
⁷ 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.
⁸ UK Severe Asthma Network, Barts Health NHS Trust and Queen Mary University of London, London, United Kingdom.
⁹ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
¹⁰ Department of Internal Medicine, Division of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.
¹¹ Personalized Medicine Asthma & Allergy Clinic, Humanitas University & Research Hospital, Milan, Italy and SANI-Severe Asthma Network Italy, Italy.
¹² 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.
¹³ Allergy, Asthma & Clinical Immunology Service, Alfred Health, Melbourne, VIC, Australia; Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
¹⁴ Department of Thoracic Medicine, Concord Hospital, Sydney, NSW, Australia.
¹⁵ Australian Severe Asthma Network, Priority Research Centre for Healthy Lungs, University of Newcastle, Newcastle, NSW, Australia.
¹⁶ AstraZeneca plc, Cambridge, United Kingdom.
¹⁷ Optimum Patient Care Global Ltd, Cambridge, England.
¹⁸ Optimum Patient Care Global Ltd, Cambridge, England; Observational and Pragmatic Research Institute, Singapore, Republic of Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom. Electronic address: dprice@opri.sg.

PMID: 31785254
DOI: 10.1016/j.chest.2019.10.053

Abstract

Background: Clinical characteristics of the international population with severe asthma are unknown. Intercountry comparisons are hindered by variable data collection within regional and national severe asthma registries. We aimed to describe demographic and clinical characteristics of patients treated in severe asthma services in the United States, Europe, and the Asia-Pacific region.

Methods: The International Severe Asthma Registry retrospectively and prospectively collected data in patients with severe asthma (≥ 18 years old), receiving Global Initiative for Asthma (GINA) Step 5 treatment or with severe asthma remaining uncontrolled at GINA Step 4. Baseline demographic and clinical data were collected from the United States, United Kingdom, South Korea, Italy, and the Severe Asthma Web-based Database registry (including Australia, Singapore, and New Zealand) from December 2014 to December 2017.

Results: We included 4,990 patients. Mean (SD) age was 55.0 (15.9) years, and mean (SD) age at asthma onset was 30.7 (17.7) years. Patients were predominantly female (59.3%) and white (72.6%), had never smoked (60.5%), and were overweight or obese (70.4%); 34.9% were at GINA Step 5; and 57.2% had poorly controlled disease. A total of 51.1% of patients were receiving regular intermittent oral corticosteroids, and 25.4% were receiving biologics (72.6% for those at GINA Step 5). Mean (SD) exacerbation rate was 1.7 (2.7) per year. Intercountry variation was observed in clinical characteristics, prescribed treatments, and biomarker profiles.

Conclusions: Using a common data set and definitions, this study describes severe asthma characteristics of a large patient cohort included in multiple severe asthma registries and identifies country differences. Whether these are related to underlying epidemiological factors, environmental factors, phenotypes, asthma management systems, treatment access, and/or cultural factors requires further study.

Keywords: Feno; IgE; biologics; comorbidity; eosinophils.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Asthma* / diagnosis
Asthma* / epidemiology
Asthma* / physiopathology
Asthma* / therapy
Comorbidity
Disease Progression
Female
Glucocorticoids / therapeutic use*
Humans
International Cooperation
Male
Medication Therapy Management / statistics & numerical data
Middle Aged
Needs Assessment
Obesity / epidemiology*
Registries / statistics & numerical data
Severity of Illness Index
White People / statistics & numerical data

Substances

Glucocorticoids