Approximately 30-50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid/long-acting β 2 agonist (ICS/LABA) therapy. Data on prevalence and burden of uncontrolled asthma in specialty settings is lacking.
To assess prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the US.
Adults with physician-diagnosed asthma attending pulmonary/allergy clinics with self-reported ICS use in the previous 4 weeks completed an electronic questionnaire including the Asthma Control Test (ACT) and St George’s Respiratory Questionnaire (SGRQ). Additional information was collected using an electronic case report form. Results Of 774 patients attending 12 pulmonary and 12 allergy clinics, 53% were not well controlled (mean [standard deviation; SD] ACT: 14.3 [3.6] vs 22.4 [1.6] in wellcontrolled patients). Among ICS/LABA users, 56% were not well controlled, which increased with increasing ICS dose (low-dose 45.7%; high-dose 59.7%). The not wellcontrolled group reported more respiratory illnesses, more comorbidities, and poorer health-related quality of life (mean [SD] SGRQ: 46.1 [18.9] vs 19.8 [12.9] in the wellcontrolled group). These patients also had more asthma exacerbations (≥1 exacerbation: 68.9% vs 43.1%) and increased healthcare resource utilization (≥1 asthma-related hospitalization: 10.7% vs 2.7%); 27.3% were also receiving systemic corticosteroids. Approximately 40% of the population were eligible for step-up to ICS/LABA/long-acting muscarinic antagonist triple therapy, and 20% were eligible for biologic therapy.
Substantial unmet needs exist among patients with inadequately controlled asthma managed in US specialist settings, which may be addressed by improved patient/physician education, better guideline implementation and improved adherence.

Copyright © 2020. Published by Elsevier Inc.

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