The Patients’ Experience of Severe Asthma Add-On Pharmacotherapies: A Qualitative Descriptive Study

Abstract

Purpose

Add-on therapies for severe asthma are continually emerging with proven efficacy in randomised controlled trials. To date, however, there are no qualitative studies exploring patients’ experiences with these treatments. We aimed to understand the experience of patients who were treated with an add-on therapy for their severe asthma.

Patients and Methods

A qualitative descriptive study was conducted, participants were recruited from the respiratory clinics and databases of a tertiary referral hospital. Participants with treatment-refractory severe asthma (n=20) prescribed an add-on therapy for >4 months (75% mepolizumab; 25% omalizumab, and 25% macrolide) were recruited. Qualitative semi-structured interviews were conducted, with interviews thematically analysed.

Results

Participants’ mean (SD) age was 59.5 (15.3) years, and 50% were male. Participants reported 4.5 (2.3) exacerbations in the past year. Asthma Control Questionnaire score was 2.0 (1.4). The monoclonal add-on therapies had been prescribed for a median (IQR) of 12.5 (7.0, 24.0) months. Experience was captured in four emergent themes: “Life is just easier” provided an overall message that the add-on therapy made the participants’ life easier in terms of increasing participation, levelling out symptoms, providing more energy and reducing healthcare use. “Prednisone: A necessary evil” was discussed, particularly in terms of dose and dependence and damaging side effects. The theme “worry and hope for the future” referenced treatment non-response or cessation of effect which was discussed by some participants. Finally, “holistic care” was centred on the sentiment that the participant’s asthma management and overall health were not related to one aspect or medication alone.

Conclusion

Patients with severe asthma experience vast improvements in quality-of-life and life participation with add-on therapies, but there remains a significant burden related to oral corticosteroids and incomplete treatment responses. Addressing this residual burden is an important area for future research.

Keywords:

• severe asthma
• asthma medications
• monoclonal antibody therapies
• quality of life
• patient experience

Acknowledgments

The authors would like to thank the study participants involved in this study. Special thanks to Leonie Jones and Jenny Darcy (Severe Asthma Outpatient Clinic-John Hunter Hospital, Newcastle, Australia), Kelly Steel, Amber Smith and Paola Urroz (Priority Research Centre for Healthy Lungs, University of Newcastle) for their assistance with recruitment.

Disclosure

Dr Vanessa Clark received a fellowship from the National Health and Medical Research Council, Centre of Research Excellence in Severe Asthma, and reports personal speaking fees from Astra Zeneca for work outside the submitted manuscript. Prof. Gibson reports personal fees from AstraZeneca, GlaxoSmithKline, Novartis, grants from AstraZeneca, GlaxoSmithKline, outside the submitted work. Prof. McDonald reports grants from Hunter Medical Research Institute, grants from National Health and Medical Research Council, grants from John Hunter Hospital Charitable Trust Research Grants, during the conduct of the study; grants and personal fees from GSK from Menarini for educational content, grants and personal fees from Astra Zeneca, outside the submitted work. The authors report no other conflicts of interest in this work.

Additional information

Funding

This work was supported by the Centre of Research Excellence in Severe Asthma.