“Asthma diagnosis and management are based on an unclear combination of subjective, symptom-based measurements (such as daytime and nighttime symptoms and activity impairment) and objective measurements (such as short-acting bronchodilator use and pulmonary function measurements),” explains Weily Soong, MD. “Objective measurements—especially the number of asthma exacerbations and pulmonary function testing—have become the main endpoints in many clinical trials for asthma. However, asthma research has often underappreciated the impact of asthma on quality of life (QOL). In a real-world setting, a patient’s QOL influences their clinician’s treatment decisions. The lives of patients with severe asthma, and their families and loved ones, are substantially affected by their disease. Asthma research mostly focuses on preventing disease exacerbations and life-threatening events, which is critical. However, the day-to-day burden of patients living with severe asthma is also substantial and has not been well-characterized.”

For a paper published in the Journal of Asthma and Allergy, Dr. Soong and colleagues assessed the burden of severe asthma by examining patients enrolled in a large, observational study of patients treated by United States allergists and pulmonologists. Patients completed in-depth surveys regarding the impact of the disease on their QOL (symptoms, activity, and psychosocial aspects) and their work productivity. The researchers summarized these survey results from 1,109 patients enrolled in the first 2 years of the study.

Biologic Treatment Found Effective

“It is clear that severe asthma significantly affects patient QOL, work productivity, and overall activity level,” Dr. Soong says. “We found that activity impairment appeared to be a major driver of overall QOL. Additionally, we discovered that biologic treatment for severe asthma was associated with improved QOL and work productivity.”

The study team examined the overall correlation between patients’ scores on the QOL survey (overall and across the components of symptoms, activity, and psychosocial impacts) with their overall reported health. “These data support the validity of the QOL survey in patients with severe asthma and also underscore the high degree of patient-to-patient variability across these components (Figure),” Dr. Soong says.

Patients were also asked for free-text responses to “other activities that your respiratory problems may prevent you from doing,” beyond the items specifically asked about in the QOL survey. A “word cloud” was then created from total responses. “The largest word in the word cloud was ‘going,’ which highlights that patients are prevented from going and doing a multitude of things because of their disease,” Dr. Soong notes, adding that there is a wide-ranging impact of severe asthma on patients’ lives due to the severity and heterogeneity of the disease.

Ask QOL-Focused Questions

“To better understand their patients and the impact of severe asthma on their lives, specialists and their staff should ask patients about activity impairment, work productivity, and psychosocial impacts in addition to asking about symptoms and exacerbations,” Dr. Soong notes. “Our results and those of prior research suggest that patients with chronic disease can adapt their expectations regarding QOL over time and, thus, underestimate the full effects of their disease. Our findings further underscore the need to ask about specific patient abilities with regard to physical activity and work productivity, rather than a more general question like, ‘How is your asthma?’”

Dr. Soong and colleagues concur that much more research is needed to explore the full effects of severe asthma on patient QOL and work productivity. “Our study did not include children and adolescents with severe asthma, and that group should be studied in the future,” he says. “Also, given the design of our study, there is reason to believe our findings underestimate the true disease burden among patients with severe uncontrolled asthma. As a result, additional studies would be valuable. Furthermore, more research needs to be done on how to measure QOL practically, easily, and consistently in a real-world setting. Finally, we need to explore factors and interventions that can affect patient QOL in the longer-term.”