Clinical characteristics and burden of illness among adolescent and adult patients with severe asthma by asthma control: the IDEAL study

Abstract

Objectives

Severe asthma (SA) can be uncontrolled despite guideline-directed treatment. We described SA characteristics and identified factors associated with uncontrolled disease and frequent exacerbations.

Methods

Post hoc analysis of the observational IDEAL study (201722/NCT02293265) included patients with SA aged ≥12 years receiving high-dose inhaled corticosteroids plus additional controller(s) for ≥12 months. Uncontrolled SA was defined by Asthma Control Questionnaire (ACQ)-5 scores ≥1.5 or ≥1 exacerbations (prior year), and further stratified by exacerbation frequency (no/infrequent [0–1] vs frequent [≥2]; prior year); associated factors were determined using multivariate logistic regression.

Results

Of 670 patients with SA, 540 (81%) were uncontrolled (ACQ-5 scores ≥1.5: 80%; ≥1 exacerbations [prior year]: 71%). Uncontrolled patients had lower lung function and worse health-related quality of life (HRQoL) than controlled patients; 197/540 (37%) experienced frequent exacerbations (prior year). Worse St George’s Respiratory Questionnaire (SGRQ) total score, comorbid sinusitis, or eczema were significantly associated with uncontrolled SA; younger age, never smoker status, exacerbation requiring hospitalization (previous year), worse SGRQ symptom score, comorbid nasal polyps, COPD, or osteoporosis were significantly associated with uncontrolled SA with frequent exacerbations.

Conclusions

In IDEAL, one-fifth of patients with SA were controlled, based on symptoms. Uncontrolled, exacerbating SA was associated with specific comorbidities, frequent exacerbations, a lower lung function, and compromised HRQoL, although inference from this analysis is limited by the selective cross-sectional nature of the cohort. Nonetheless, these data highlight the need for more effective precision treatments in this population.

Keywords:

• Control/management
• morbidity and mortality
• quality of life

Acknowledgements

Editorial support (in the form of writing assistance, including development of the initial draft based on author direction, assembling tables and figures, collating and incorporating authors' comments, grammatical editing, and referencing) was provided by Alex Lowe, PhD, and Elizabeth Hutchinson, PhD, CMPP, at Fishawack Indicia Ltd, UK, and was funded by GlaxoSmithKline (GSK).

Declaration of interest

SMC, NBG, and LMN are employees of GSK and own stocks/shares. HM and FCA were employees of GSK at the time of the study and submission, and own stocks/shares in GSK; HM is now employed by AstraZeneca and FCA is now employed by Avillion.

Author’s contributions

All authors (HM, SMC, NBG, LMN, and FCA) were involved in study conception and design, data analysis and interpretation, preparation and review of the manuscript, and approved the final version to be submitted.

Funding source and role

This post hoc analysis and the original study were funded by GSK (Study 201722; NCT02293265).

Data sharing

Anonymized individual participant data and study documents for the original IDEAL study can be requested for further research from www.clinicalstudydatarequest.com.