Characterization of uncontrolled, severe asthma patients with type 2 inflammation (T2): results from a physician survey across countries from Latin American, Eurasian Middle East regions and China

Figures & data

Table 1. T2 inflammation comorbidities.

T2 comorbidity	Characteristics	Links with asthma
Chronic rhinosinusitis with nasal polyps (CRSwNP)	Eosinophil-rich nasal polyps Chronic sinusitis Mucus production (12)	Associated with premorbid and concurrent asthma, (15) and more severe asthma, especially in patients with nasal polyps; (1) appears to be driven by the IL-4/IL-13 pathway also associated with asthma and atopic dermatitis (11)
Atopic dermatitis	Bright red, flat areas of skin with oozing or exudate changing into dull red or pink and dry, lichenified skin Impaired skin barrier Transepidermal water loss (13)	Common allergic disease associated with asthma; may be associated with systemic type 2 inflammation (13)
Allergic rhinitis and rhinosinusitis	Sneezing, rhinorrhea, and nasal obstruction Postnasal drip, cough, irritability, and fatigue (16)	Patients with uncontrolled, persistent asthma are more susceptible to these conditions (17)

Table 2. Summary of main patient data reported by physicians.

Patient demographics	Age, gender
Patient health history	Comorbidities, especially atopic dermatitis, allergic rhinitis, and CRSwNP
Patient asthma history/status	Asthma age of onset, blood eosinophil (EOS) level ^a , Immunoglobulin E (IgE) levels ^a , FeNO measurement ^a , FEV1 % predicted ^a , # of exacerbations in the past 12 months, # of exacerbations requiring hospitalization in the past 12 months, # of ambulance calls in the previous year (Russia only), # of emergency room (ER) visits in the previous year (excluding Russia), GINA Step (based on the physician’s assessment) ^b
Treatment	Current treatment regimen, change in brand of biologic treatment (if applicable), treatment before biologic initiated (if applicable), OCS use before biologic initiated (if applicable), current OCS use, frequency of acute OCS use, duration of chronic OCS use, Asthma Control Test (ACT) or Asthma Control Questionnaire (ACQ) score, control on current treatment regimen

a Most recent test result was reported (prior to any biologic initiation, if applicable).

b Based on the physician’s assessment; physicians were exposed to the 2014 ERS/ATS definition in the declarative portion of the survey.

Table 3. Physician demographics.

Physician demographics	BRA (n = 70)	MEX (n = 71)	COL (n = 70)	RUS (n = 72)	UAE (n = 70)	KSA (N = 60)	TUR (n = 67)	CHN (n = 70)
Primary specialty (%)
Pulmonology	64	49	50	50	64	100	52	41
Allergy/allergology	36	51	36	50	14	–	48	30
Immunology	–	–	–	–	22	–	–	29
General practitioner/primary care	–	–	14	–	–	–	–	–
Gender (%)
Male	64	59	63	24	69	83	45	61
Female	36	41	37	76	31	17	55	39
Years in practice (mean, SD)	14.2 (6.6)	13.2 (6.7)	12.7 (7.9)	15.7 (7.1)	15.9 (7.0)	17.8 (7.5)	15.1 (7.5)	15.3 (5.9)
Practice setting (%)
Rural	1	–	1	–	N/A	N/A	3	7
Suburban	–	–	3	3	N/A	N/A	–	9
Urban	99	100	96	97	N/A	N/A	97	84
Number of asthma patients seen per month (mean, SD)	132 (99)	103 (98)	89 (74)	124 (120)	105 (96)	109 (76)	169 (120)	128 (88)
Average proportion of asthma patients seen by age group (%)
Asthma patients age 12–17	31	41	38	35	20	28	18	33
Asthma patients age 18+	69	59	62	65	80	72	82	67

Table 4. Patient demographics: uncontrolled, high-dose ICS (+ ≥1 controller) asthma patients age 12+.

Patient demographics	All (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
Gender (%)
Male	43	37	51	40	55	45	53	52	54
Female	57	63	49	60	45	55	47	48	46
Age (mean, SD)	43 (19)	45 (17)	34 (17)	40 (18)	44 (21)	37 (12)	34 (14)	52 (15)	51 (21)
#, % of patients with ACT scores	n = 402 46%	n = 28, 24%	n = 72, 53%	n = 73, 58%	n = 62, 48%	n = 7, 13%	n = 5, 9%	n = 110, 70%	n = 45, 44%
ACT score (mean, SD)	16.5 (4.3)	15.0 (4.6)	16.9 (3.9)	15.5 (4.1)	16.5 (4.9)	20.4 (4.2)	14.2 (5.1)	17.1 (4.1)	16.2 (4.2)
#, % of patients with ACQ scores	n = 169 19%	n = 13, 11%	n = 13, 9.6%	n = 3, 2.3%	n = 41, 32%	n = 4, 7%	n = 1, 2%	n = 61, 39%	n = 33, 32%
ACQ score (mean, SD)	2.5 (1.5)	4.1 (1.2)	2.4 (1.8)	1.4 (2.2)	2.4 (1.3)	3.0 (0.8)	2.0 (0.0)	1.8 (1.0)	3.5 (1.4)
#, % of patients with FEV1 test values	n = 652 74%	n = 79, 67%	n = 98, 72%	n = 106, 84%	n = 108, 84%	n = 27, 48%	n = 16, 30%	n = 147, 94%	n = 71, 70%
FEV1 test value, % of predicted value (mean, SD)	63.0 (14.2)	59.3 (14.0)	66.5 (13.7)	68.2 (14.3)	57.4 (14.8)	62.0 (12.6)	58.0 (19.2)	63.0 (11.7)	64.6 (14.4)

Table 5. Asthma severity: uncontrolled, high-dose ICS (+ ≥1 controller) patients age 12+.

Asthma severity	All (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
OCS use (%) ^a
Yes: chronic	11	7	14	10	11	9	17	17	5
Yes: acute	12	12	20	8	10	16	8	6	22
No	76	81	66	82	79	75	75	76	74
GINA step (physician-reported) (%) ^b
Step 1	1	–	–	1	2	2	2	–	4
Step 2	4	5	3	3	1	7	6	1	12
Step 3	22	22	23	18	30	36	15	17	21
Step 4	51	57	48	50	62	39	45	50	49
Step 5	21	16	26	28	5	16	32	31	15
Patients with Biologic add-on to current treatment (%)	15	4	19	22	6	11	2	14	24

a Based on physician’s assessment.

b GINA Step was physician-reported and based on the physician’s assessment, not on the treatment regimen.

Table 7. Biomarker-based phenotypes: Uncontrolled, high-dose ICS (+ ≥1 controller) asthma patients age 12+.

Biomarker-based phenotypes	All (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
#, % of patients with blood EOS lab data	n = 420, 48	n = 41, 35	n = 60, 44	n = 66, 52	n = 83, 64	n = 16, 29	n = 5, 9	n = 113, 72	n = 36, 35
EOS (cells/µL) (mean, SD)	203.0 (265.9)	222.4 (198.6)	376.2 (332.1)	236.9 (236.4)	107.6 (185.6)	154.2 (222.5)	179.0 (239.5)	80.7 (189.0)	459.3 (310.6)
EOS ≥150 cells/µL (%)	40	56	67	55	23	38	20	16	72
EOS ≥300 cells/µL (%)	31	37	60	33	20	19	20	12	67
EOS ≥400 cells/µL (%)	25	20	47	23	17	19	20	10	67
#, % of patients with FeNO lab data	n = 65, 7	n = 10, 8	n = 3. 2	n = 1, 1	n = 16, 12	n = 4, 7	n = 0, 0	n = 0, 0	n = 31, 31
FeNO (ppb) (mean, SD)	90.7 (52.3)	60.4 (8.8)	66.7 (30.6)	81.0 (0.0)	45.8 (30.6)	50.5 (23.6)	–	–	131.4 (43.1)
FeNO ≥20 ppb (%)	98	^a	^a	^a	^a	^a	–	–	97
FeNO ≥25 ppb (%)	95	^a	^a	^a	^a	^a	–	–	97
#, % of patients with IgE lab data	n = 498, 57	n = 53, 45	n = 91, 7	n = 79, 63	n = 92, 71	n = 17, 30	n = 11, 21	n = 120, 76	n = 35, 34
IgE (IU/mL) (mean, SD)	437.1 (730.6)	746.3 (1174.8)	625.8 (1122.6)	324.2 (386.8)	413.9 (377.3)	516.3 (516.3)	444.7 (350.2)	222.4 (517.0)	489.5 (302.2)
IgE 30 − 1500 IU/mL (%)	91	89	95	84	97	82	73	95	89
IgE >700 IU/mL (%)	5	2	11	5	–	6	–	6	14
#, % of patients with EOS or FeNO lab data	n = 426, 49	n = 41, 35	n = 62, 46	n = 66, 52	n = 86, 67	n = 17, 30	n = 5, 9	n = 113, 72	n = 36, 35
#,% of patients with both EOS and FeNO lab data	n = 59, 7	n = 10, 8	n = 1, 1	n = 1, 1	n = 13, 10	n = 3, 5	n = 0	n = 0	n = 31, 30
EOS <150 and FeNO ≥25 ppb (%)	54	^a	^a	^a	^a	^a	–	–	24
#, % of patients with EOS or IgE lab data	n = 545, 62	n = 58, 49	n = 103, 76	n = 86, 68	n = 104, 80	n = 23, 41	n = 11, 21	n = 122, 78	n = 38, 37
EOS ≥300 cells/µL or IgE 30 − 1500 IU/mL (%)	88	90	95	83	86	65	73	94	82

a Very limited sample size.

Figure 1. T2 inflammation comorbidities: Uncontrolled, high-dose ICS (+ >1 controller) patients age 12+. *AD = atopic dermatitis; CRSwNP = chronic rhinosinusitis with nasal polyps; AR = allergic rhinitis.

Table 8. T2 inflammation comorbidities: Uncontrolled, high-dose ICS (+ ≥1 controller) patients age 12+.

T2 inflammation comorbidities	All (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
Do not have any T2 comorbidities (%)	35	25	22	26	43	21	26	55	43
Has AD; does not have CRSwNP or AR (%)	4	1	5	4	5	7	4	2	5
Has CRSwNP; does not have AD or AR (%)	4	1	2	3	8	4	6	4	7
Has AR; does not have AD or CRSwNP (%)	35	50	39	43	23	36	34	25	29
Has AD and CRSwNP; does not have AR (%)	1	–	–	1	–	2	–	1	2
Has AD and AR; does not have CRSwNP (%)	11	12	15	13	16	11	8	4	5
Has CRSwNP and AR; does not have AD (%)	8	7	12	8	2	11	21	6	9
Has AD, CRSwNP, and AR (%)	3	4	5	2	3	9	2	2	–

Table 6. Exacerbation: uncontrolled, high-dose ICS (+ ≥1 controller) patients age 12+.

Exacerbation history	All (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
# of exacerbations, past 12 months (%)
0	4	1	2	9	2	5	11	3	–
1+	96	99	98	91	98	95	89	97	100
2+	80	88	79	65	90	86	75	64	98
3+	58	58	53	45	74	68	57	43	83
4+	39	37	30	33	46	46	36	30	64
# of exacerbations, past 12 months (patients with at least one exacerbation) (mean, SD)	4.1 (4.8)	4.7 (7.2)	3.4 (3.1)	3.2 (3.3)	5.0 (6.0)	3.9 (3.2)	3.1 (2.1)	2.9 (2.7)	6.6 (5.8)
# of exacerbations requiring hospitalization (patients with at least one exacerbation), past 12 months (%)
0	24	43	33	30	12	26	36	14	4
1+	76	57	67	70	88	74	64	86	96
2+	42	30	33	35	56	34	30	36	79
3+	22	13	16	17	33	15	11	13	58
4+	13	9	7	9	17	4	4	7	45
# of exacerbations requiring hospitalization, past 12 months (patients with at least one exacerbation) (mean, SD)	1.9 (2.5)	1.4 (2.6)	1.3 (1.5)	1.5 (1.8)	2.2 (1.9)	1.4 (1.6)	1.2 (1.3)	1.5 (1.2)	4.9 (4.4)
# of ER visits in the previous year ^a (%)
0	11	9	13	17	12	14	28	4	1
1+	89	91	87	83	88	86	72	96	99
2+	68	75	56	60	74	73	49	64	88
3+	50	52	32	48	61	55	38	43	77
4+	36	35	21	37	50	34	28	26	57
# of ER visits in the previous year ^a (mean, SD)	3.7 (4.8)	3.6 (5.1)	2.5 (3.0)	2.9 (2.8)	5.2 (5.7)	3.4 (3.8)	2.6 (2.9)	3.1 (3.4)	6.3 (7.9)

a For Russia, Physicians reported the number of ambulance calls in the previous year per patient; in all other countries, physicians reported the # of ER visits in the previous year per patient, for all patients.

Table A4. Biomarker-based phenotypes: Uncontrolled, high-dose ICS (+ ≥1 controller) asthma patients age 18+.

Biomarker-based phenotypes	Global (n = 648)	BRA (n = 104)	MEX (n = 75)	COL (n = 79)	RUS (n = 92)	UAE (n = 48)	KSA (n = 46)	TUR (n = 131)	CHN (n = 73)
#, % of patients with blood EOS lab data	n = 298, 46	n = 37, 36	n = 35, 47	n = 34, 43	n = 58, 63	n = 12, 25	n = 4, 9	n = 90, 69	n = 28, 38
EOS (cells/µL) (mean, SD)	206.53 (264.1)	217.8 (200.8)	397.4 (325.2)	238.0 (234.8)	132.7 (199.2)	141.2 (170.9)	211.3 (263.7)	64.6 (157.6)	551.2 (274.2)
EOS ≥ 150 cells/µL (%)	41	64	71	59	29	42	25	13	82
EOS ≥ 300 cells/µL (%)	32	43	66	24	26	25	25	10	82
EOS ≥ 400 cells/µL (%)	25	27	49	15	21	17	25	8	82
#, % of patients with FeNO lab data	n = 49, 8	n = 10, 10	n = 0. 0	n = 0, 0	n = 10, 11	n = 3, 6	n = 0, 0	n = 0, 0	n = 26, 36
FeNO (ppb) (mean, SD)	101.2 (52.6)	60.4 (8.8)	–	–	50.5 (38.5)	54 (27.6)	–	–	141.9 (31.8)
FeNO ≥ 20 ppb (%)	100	100	–	–	100	100	–	–	100
FeNO ≥ 25 ppb (%)	96	100	–	–	80	100	–	–	100
#, % of patients with IgE lab data	n = 341, 53	n = 47, 45	n = 44, 59	n = 44, 56	n = 60, 65	n = 13, 27	n = 9, 20	n = 96, 73	n = 28, 38
IgE (IU/mL) (mean, SD)	406.0 (688.5)	745.5 (1231.6)	567.8 (916.9)	208.1 (218.7)	368.3 (338.1)	534.8 (587.1)	499 (353.7)	217.3 (531.3)	531 (268.1)
IgE 30 − 1500 IU/mL (%)	90	89	89	75	95	77	78	95	93
IgE > 700 IU/mL (%)	15	23	22	2	15	31	22	4	36
#,% of patients with both EOS and FeNO lab data	n = 45, 7	n = 10, 8	–	–	n = 7, 8	n = 2, 4	–	–	n = 23, 32
EOS < 150 and FeNO ≥ 25 ppb (%)	54	20	*	*	43	100	–	–	88

Table A5. T2 inflammation comorbidities: Uncontrolled, high-dose ICS (+ ≥1 controller) patients age 18+.

T2 inflammation comorbidities	Global (n = 876)	BRA (n = 118)	MEX (n = 135)	COL (n = 126)	RUS (n = 129)	UAE (n = 56)	KSA (n = 53)	TUR (n = 157)	CHN (n = 102)
Do not have any T2 comorbidities (%)	39	28	33	32	52	23	24	56	48
Has AD; does not have CRSwNP or AR (%)	3	1	4	4	5	6	4	2	7
Has CRSwNP; does not have AD or AR (%)	4	1	2	3	9	4	2	5	5
Has AR; does not have AD or CRSwNP (%)	33	50	32	42	25	38	35	24	26
Has AD and CRSwNP; does not have AR (%)	–	–	–	–	–	2	–	2	0
Has AD and AR; does not have CRSwNP (%)	7	9	8	10	4	8	9	3	7
Has CRSwNP and AR; does not have AD (%)	8	7	15	8	–	10	24	6	7
Has AD, CRsWNP and AR (%)	4	5	3	2	4	4	2	2	–

Table A1 Patient demographics: uncontrolled, high-dose ICS (+ ≥1 controller) asthma patients age 18+.

Patient demographics	Global (n = 648)	BRA (n = 104)	MEX (n = 75)	COL (n = 79)	RUS (n = 92)	UAE (n = 48)	KSA (n = 46)	TUR (n = 131)	CHN (n = 73)
Gender (%)
Male	48	48	46	43	47	46	58	52	59
Female	52	52	54	57	53	55	42	48	41
Age (mean, SD)	47 (16)	46 (15)	40 (14)	42 (15)	50 (15)	39 (12)	39 (12)	52 (15)	52 (19)
Patient satisfaction with treatment on a scale of 1 to 7 (1 = not at all satisfied; 7 = extremely satisfied) (%)
7	6	3	12	14	8	20	11	5	3
6	17	17	27	22	15	42	15	16	15
5	24	30	23	26	23	24	22	27	22
4	24	28	22	16	33	7	20	32	14
3	19	16	12	16	13	4	21	12	25
2	8	5	2	4	7	3	9	6	16
1	2	0	2	2	2	0	2	2	5
#, % of patients with ACT scores	n = 292 45	n = 23, 22	n = 41, 55	n = 46, 58	n = 44, 48	n = 6, 12	n = 4, 9	n = 92, 70	n = 36. 49
ACT score (mean, SD)	16.1 (4.2)	15.3 (4.7)	16.7 (3.4)	15.0 (4.1)	15.9 (5.0)	20.2 (4.6)	14.8 (5.7)	16.4 (4.1)	16.2 (4.1)
#, % of patients with ACQ scores	n = 129 20	n = 13, 12	n = 11, 12	n = 1, 1	n = 31, 34	n = 3, 6	n = 0, 0	n = 48, 37	n = 24, 33
ACQ score (mean, SD)	2.7 (1.4)	4.1 (1.2)	3.2 (1.6)	4 (0)	2.1 (1.2)	3.0 (1.0)	0 (0.0)	1.8 (1.0)	3.8 (1.1)
#, % of patients with FEV1 test values	n = 474 73	n = 67, 64	n = 56, 75	n = 67, 85	n = 78, 85	n = 23, 48	n = 14, 30	n = 122, 93	n = 47, 64
FEV1 test value, % of predicted value (mean, SD)	61.6 (13.7)	58.3 (14.1)	64.5 (12.1)	66.2 (13.6)	55.7 (15.3)	62.0 (12.9)	61.0 (13.7)	63.0 (11.2)	62.0 (15.3)

Table A2. Asthma severity: uncontrolled, high-dose ICS (+ ≥1 controller) patients age 18+.

Asthma severity	Global (n = 648)	BRA (n = 104)	MEX (n = 75)	COL (n = 79)	RUS (n = 92)	UAE (n = 48)	KSA (n = 46)	TUR (n = 131)	CHN (n = 73)
OCS use (%)*
Yes-chronic	14	8	16	15	13	10	20	21	7
Yes-acute	15	13	29	10	11	17	9	8	27
No	71	79	55	75	76	73	73	72	66
GINA step (physician-reported) (%)**
Step 1	1	–	–	–	–	2	–	–	4
Step 2	4	6	–	4	1	6	4	2	14
Step 3	24	21	28	27	26	38	15	19	25
Step 4	56	60	57	52	66	44	46	55	53
Step 5	16	13	15	18	7	10	35	24	4
Patients with Biologic add-on to current treatment (%)	6	9	29	32	13	15	9	15	29

Table A3. Exacerbation: uncontrolled, high-dose ICS (+ ≥1 controller) patients age 18+.

Exacerbation history	Global (n = 648)	BRA (n = 104)	MEX (n = 75)	COL (n = 79)	RUS (n = 92)	UAE (n = 48)	KSA (n = 46)	TUR (n = 131)	CHN (n = 73)
# of exacerbations, past 12 months (%)
0	3	1	1	8	3	6	7	2	–
1+	97	99	99	92	97	94	93	98	100
2+	80	87	79	62	90	88	80	64	99
3+	57	55	48	47	71	68	61	44	81
4+	38	35	29	35	40	44	39	31	58
# of exacerbations, past 12 months (patients with at least one exacerbation) (mean, SD)	3.9 (4.5)	4.8 (7.6)	3.3 (3.6)	3.3 (3.6)	4.1 (4.3)	3.8 (3.3)	3.3 (2.1)	3.0 (2.7)	6.0 (5.0)
# of exacerbations requiring hospitalization (patients with at least one exacerbation), past 12 months (%)
0	15	42	34	30	12	31	37	14	5
1+	76	58	66	70	88	69	63	86	995
2+	40	30	31	35	56	29	26	33	74
3+	20	13	14	17	29	16	9	14	49
4+	11	9	8	9	9	4	5	8	36
# of exacerbations requiring hospitalization, past 12 months (patients with at least one exacerbation) (mean, SD)	1.7 (2.2)	1.4 (2.7)	1.3 (1.7)	1.4 (1.6)	2.0 (1.6)	1.3 (1.7)	1.1 (1.3)	1.5 (1.3)	3.8 (3.5)
# of ER visits in the previous year* (%)
0	16	11	15	20	11	17	30	3	1
1+	84	89	85	80	89	83	70	97	99
2+	62	73	51	56	68	73	52	63	86
3+	45	51	31	49	53	56	39	46	75
4+	30	34	21	37	37	35	28	28	53
# of ER visits in the previous year* (mean, SD)	3.2 (4.2)	3.7 (5.5)	2.5 (3.5)	2.9 (2.9)	5.3 (5.6)	3.5 (4.1)	2.6 (2.9)	3.2 (3.6)	5.9 (7.5)

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