Management of patients with severe asthma: results from a survey among allergists and clinical immunologists of the Central Italy Inter-Regional Section of SIAAIC

Abstract Background Asthma, and severe asthma in particular, is often managed within a specialized field with allergists and clinical immunologists playing a leading role. In this respect, the National Scientific Society SIAAIC (Società Italiana di Allergologia, Asma ed Immunologia Clinica), structured in Regional and Inter-Regional sections, interviewed a large number of specialists involved in the management of this respiratory disease. Methods A survey entitled “Management of patients with asthma and severe asthma” based on 17 questions was conducted through the SIAAIC newsletter in 2019 thanks to the collaboration between GlaxoSmithKline S.p.A. and the Inter-Regional Section of SIAAIC of Central Italy. Results Fifty-nine allergists and clinical immunologists participated to the survey, and 40 of them completed the entire questionnaire. Almost all of the specialists (88%) reported that asthma control was achieved in above 50% of their patients, even if only one third (32%) actually used validated clinical tools such as asthma control test (ACT). Poor adherence to inhaled therapy was recognized as the main cause of asthma control failure by 60% of respondents, and 2–5 min on average is dedicated to the patient inhaler technique training by two-thirds of the experts (65%). Maintenance and as-needed therapy (SMART/MART) is considered an appropriate approach in only a minority of the patients (25%) by one half of the respondents (52%). A high number of exacerbations despite the maximum inhalation therapy were recognized as highly suspicious of severe asthma. Patients eligible for biological therapies are 3–5% of the patients, and almost all the responders (95%) agreed that patients affected by severe asthma need to be managed in specialized centers with dedicated settings. Biological drugs are generally prescribed after 3–6 months from the initial access to the center, and once started, the follow-up is initially programmed monthly, and then every 3–6 months after the first year of treatment (96% of responders). After phenotyping and severity assessment, comorbidities (urticaria, chronic rhinosinusitis with or without nasal polyps, vasculitis, etc.) are the drivers of choice among the different biological drugs. In the management of severe asthma, general practitioners (GPs) should play a central role in selecting patients and referring them to specialized centers while Scientific Societies should train GPs to appropriately recognize difficult asthma and promote public disease awareness campaigns. Conclusions This survey which collects the point of view of allergists and clinical immunologists from Central Italy highlights that asthma control is still not measured with validated instruments. There is a general consensus that severe asthma should be managed only in dedicated centers and to this aim it is essential to encourage patient selection from a primary care setting and develop disease awareness campaigns for patients.

Download Full-text

First analysis of the Severe Paediatric Asthma Collaborative in Europe registry

ERJ Open Research ◽

10.1183/23120541.00566-2020 ◽

2020 ◽

Vol 6 (4) ◽

pp. 00566-2020

Author(s):

Norrice M. Liu ◽

Karin C.L. Carlsen ◽

Steve Cunningham ◽

Grazia Fenu ◽

Louise J. Fleming ◽

...

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Suboptimal Control ◽

High Dose ◽

Asthma Control Test ◽

European Respiratory Society ◽

Paediatric Asthma ◽

Global Initiative For Asthma ◽

Global Initiative ◽

Long Acting

New biologics are being continually developed for paediatric asthma, but it is unclear whether there are sufficient numbers of children in Europe with severe asthma and poor control to recruit to trials needed for registration. To address these questions, the European Respiratory Society funded the Severe Paediatric Asthma Collaborative in Europe (SPACE), a severe asthma registry. We report the first analysis of the SPACE registry, which includes data from 10 paediatric respiratory centres across Europe.Data from 80 children with a clinical diagnosis of severe asthma who were receiving both high-dose inhaled corticosteroid and long-acting β2-agonist were entered into the registry between January 2019 and January 2020. Suboptimal control was defined by either asthma control test, or Global Initiative for Asthma criteria, or ≥2 severe exacerbations in the previous 12 months, or a combination.Overall, 62 out of 80 (77%) children had suboptimal asthma control, of whom 29 were not prescribed a biologic. However, in 24 there was an option for starting a licensed biologic. 33 children with suboptimal control were prescribed a biologic (omalizumab (n=24), or mepolizumab (n=7), or dupilumab (n=2)), and for 29 there was an option to switch to a different biologic.We conclude that the SPACE registry provides data that will support the planning of studies of asthma biologics. Not all children on biologics achieve good asthma control, and there is need for new trial designs addressing biologic switching.

Download Full-text

Predictive Properties of the Asthma Control Test and Its Component Questions for Severe Asthma Exacerbations

The Journal of Allergy and Clinical Immunology In Practice ◽

10.1016/j.jaip.2016.06.025 ◽

2017 ◽

Vol 5 (1) ◽

pp. 121-127.e2 ◽

Cited By ~ 10

Author(s):

Sonia Cajigal ◽

Karen E. Wells ◽

Edward L. Peterson ◽

Brian K. Ahmedani ◽

James J. Yang ◽

...

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Control Test ◽

Asthma Control Test ◽

Asthma Exacerbations

Download Full-text

Asthma Control during COVID-19 Lockdown in Patients with Severe Asthma under Biological Drug Treatment

Applied Sciences ◽

10.3390/app112412089 ◽

2021 ◽

Vol 11 (24) ◽

pp. 12089

Author(s):

Corrado Pelaia ◽

Alessandro Casarella ◽

Gianmarco Marcianò ◽

Lucia Muraca ◽

Vincenzo Rania ◽

...

Keyword(s):

Asthma Control ◽

Severe Asthma ◽

Health Facilities ◽

Biological Therapies ◽

Biological Drugs ◽

Exacerbation Rate ◽

Severe Asthmatic ◽

Access To Health ◽

The Mean ◽

Act Score

Introduction: Coronavirus disease 2019 (COVID-19) has deeply affected the management of patients with severe asthma, treated with add-on biological therapies. Objective: In this study, severe asthmatic patients on treatment with one of three different biologics (omalizumab, mepolizumab, benralizumab) underwent a survey to evaluate the effects of COVID-19 on the management of their clinical condition, with regard to the changes caused by the limited access to health facilities during the pandemic period. Methods: In this prospective observational study, 28 severe asthmatic outpatients referring to the Respiratory Unit of Magna Graecia University Hospital, Catanzaro (Italy), were asked to answer a telephone survey from May to July 2021. This survey included the evaluation of demographic and clinical data, as well as the number of lung function tests performed, exacerbations, biologic doses administered at hospital, or at general practitioner office, or through self-administration. Adherence to biological therapies before and during the pandemic period was also assessed. Moreover, the most recent asthma control test (ACT) score and the last forced expiratory volume in the first second (FEV1) measurement, recorded during the pandemic phase, were compared to the pre-pandemic (baseline) period. Results: When comparing the pre-pandemic data with the pandemic observations, the mean ACT score and the exacerbation rate did not significantly change [ACT, 21.5 ± 2.8 to 23.0 ± 3.9 (p = 0.1); exacerbation rate, 0.3 ± 0.6 and 0.5 ± 1.5 (p = 0.3)]. When considering some variables related to disease management in the same periods, a statistically significant difference was detected with regard to the mean number of outpatient visits (5.2 ± 3.8 vs. 0.9 ± 2.5, p < 0.0001), as well as to the mean number of accesses to health facilities for the administration of biological drugs (from 7.0 ± 3.4 to 2.5 ± 3.9, p < 0.0001). None of the patients reported to have been infected with the SARS-CoV-2 virus and no adverse drug reactions (ADR) occurred during the study. Conclusions: The above results suggest that COVID-19 pandemic did not induce any significant change related to severe asthma control. Indeed, add-on treatment with biological drugs was regularly continued, despite the obvious limited access to health facilities.

Download Full-text

The Effect of Aspirin on Moderate to Severe Asthmatic Patients with Aspirin Hypersensitivity, Chronic Rhinosinusitis, and Nasal Polyposis.

Iranian Journal of Allergy Asthma and Immunology ◽

10.18502/ijaai.v20i3.6330 ◽

2021 ◽

Author(s):

Saba Arshi ◽

Sepideh Darougar ◽

Mohammad Nabavi ◽

Mohammad Hassan Bemanian ◽

Morteza Fallahpour ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Asthma Control ◽

Severe Asthma ◽

Nasal Polyposis ◽

Clinical Findings ◽

Act Scores ◽

Asthma Control Test ◽

Asthmatic Patients ◽

Before And After ◽

Aspirin Hypersensitivity

Asthmatic patients may have aspirin-exacerbated respiratory disease and experience acute dyspnea and nasal symptoms within 3 hours after the ingestion of aspirin. This study aimed to evaluate the effect and outcome of daily low-dose aspirin in the treatment of moderate to severe asthma in patients with concomitant aspirin hypersensitivity and chronic rhinosinusitis with nasal polyposis (CRSwNP). This clinical trial was conducted from February 2014 to February 2015 on 46 adult patients with moderate to severe asthma accompanied by CRSwNP. Patients with a positive aspirin challenge were blindly randomized in three groups receiving placebo/day (A); aspirin 100 mg/day (B); and aspirin 325mg/day (C), respectively. Clinical findings, FEV1 and ACT scores were recorded and compared before, during, and after treatment for 6 months (IRCT2015061521970N2). Of 46 participants at baseline, 30 patients completed this 6-month trial study. The level of asthma control was significant; based on Asthma Control Test (ACT) when comparing the results in groups A and C and also groups B and C, but it was not significant when comparing ACT scores between groups A and B. FEV1 before and after treatment was significant when comparing groups A and B, groups A and C, and groups B and C. To conclude, aspirin desensitization with a daily dose of 325 mg aspirin resulted in the improvement of long-term control of asthma. A daily aspirin dose of 100 mg was not associated with such an increase in ACT score.

Download Full-text

Relationship of granulocytic inflammation of bronches with the level of asthma control in patients with cold airway hyperresponsiveness under inhalation therapy of extrafine beclomethasone/formoterol

Bulletin physiology and pathology of respiration ◽

10.36604/1998-5029-2021-79-42-51 ◽

2021 ◽

pp. 42-51

Author(s):

A. B. Pirogov ◽

A. G. Prikhodko ◽

J. M. Perelman

Keyword(s):

Asthma Control ◽

Airway Hyperresponsiveness ◽

Inhalation Therapy ◽

Term Therapy ◽

Small Airways ◽

Asthma Control Test ◽

Cold Air ◽

Before And After ◽

Metered Dose ◽

Asthma Patients

Introduction. Obstruction of small airways in asthma is accompanied by greater hypersensitivity to nonspecific irritants and inflammation activity, which is associated with a worsening of the clinical course of the disease. The combination of beclomethasone dipropionate/formoterol fumarate (BDP/FF), used in the form of an extrafine metered dose aerosol, is capable of having an anti-inflammatory effect on the small airways. Dynamic changes in the structure and function of granulocytes of inflammatory bronchial infiltrate after exposure to cold air in patients with asthma treated with BDP/FF have been little studied.Aim. To study the nature of changes in eosinophil and neutrophil pools of bronchial granulocytes in asthma patients with cold airway hyperresponsiveness (CAHR) during long-term therapy with extrafine BDP/FF.Materials and methods. The clinical study involved 25 asthma patients with CAHR. The design of the work included a questionnaire survey of patients using the Asthma Control Test (ACT) questionnaire, spirometry (Easy on PC, ndd Medizintechnik AG, Switzerland), an isocapnic hyperventilation by cold air (IHCA), collection and cytological examination of induced and spontaneously produced sputum. The examination was carried out at the beginning and after 12 weeks of BDP/FF therapy (100/6 μg, twice a day).Results. 12-week treatment with extrafine BDP/FF led to an improvement in asthma control (ACT increased from 17.1±1.1 to 22.5±0.5 points, p˂0.001) and patency of small bronchi (increase in МEF50 was 0.47±0.21 L/s, МEF25-75 – 0.42±0.17 L/s). BDP/FF therapy had a positive effect on cellular inflammation, leading to a decrease in the number of eosinophils in sputum from 9.5 (3.0; 19.5) to 2.2 (1.3; 4.7)% (p˂0,05). A decrease in the number of eosinophils was also observed after cold bronchoprovocation: from 9.0 (2.8; 15.4) to 4.7 (2.8; 7.8)% (p˂0.05). There was no dynamics in neutrophils after BDP/FF treatment before and after IHCA (59.9±1.3 and 57.1±2.0%, respectively, p>0.05).Conclusion. Improvement of disease control in asthma patients with CAHR after 12 weeks of therapy with extrafine BDP/FF is associated with the regulation of eosinophilic inflammation, a decrease in the number of eosinophils in the airways and suppression of the activity of the neutrophilic pool of bronchial granulocytes in response to cold bronchoprovocation.

Download Full-text

Effectiveness and Safety of Bronchial Thermoplasty in Severe Asthma in Clinical Practice in Spain

Biomedicine Hub ◽

10.1159/000492075 ◽

2018 ◽

Vol 3 (3) ◽

pp. 1-9 ◽

Cited By ~ 1

Author(s):

Luis Puente-Maestu ◽

Milagros Llanos Flores ◽

Paola Benedetti ◽

Ingrid Frías Benzant ◽

Alicia Oliva Ramos ◽

...

Keyword(s):

Clinical Practice ◽

Asthma Control ◽

Severe Asthma ◽

Inhaled Corticosteroids ◽

Invasive Procedure ◽

First Year ◽

Asthma Control Test ◽

Bronchial Thermoplasty ◽

Oral Corticosteroids ◽

Predominantly Female

Background: Bronchial thermoplasty (BT) is a minimally invasive procedure consisting of application of thermal energy into the airways to produce ablation of the hypertrophic smooth muscle. It was approved for use in moderate-severe asthma in Spain in 2010. Objectives: The aims of the present study are to analyze the effectiveness and the safety of BT in clinical practice in our center. Methods: Participants had a confirmed diagnosis of severe asthma and poor control without therapeutic alternative. Effectiveness was measured by comparing exacerbations, admissions rates, asthma control, and medication 1 year prior and 1 year after BT was completed. All complications appearing during the procedure and in the first year were recorded. Results: Patients had a mean age of 51 (SD 8) years and were predominantly female (17/23). The average number of activations per patient was 147 (16). The number of severe exacerbations was reduced by 75% (p < 0.001). A 38% reduction in admissions per year was also observed (p = 0.03). The Asthma Control Test improved by 7.1 (3.7) points (p = 0.018). Before BT, the dose of inhaled corticosteroids was 1,621 (1,015) µg of budesonide-equivalent and the dose of oral corticosteroids was 15 (13) mg of prednisone-equivalent. There was a reduction in 430 (731) µg of budesonide-equivalent (p = 0.02) and 4 (11) mg of prednisone (p = 0.094). No changes in lung function were observed. Complications were related mostly to exacerbation of asthma in the days following the procedure. Conclusions: BT is effective and safe for severe uncontrolled bronchial asthma in real clinical practice.

Download Full-text