Clinical and Economic Burden of Severe Asthma With Low Blood Eosinophil Counts

IF 8.2 1区医学 Q1 ALLERGY Journal of Allergy and Clinical Immunology-In Practice Pub Date : 2024-10-01 DOI:10.1016/j.jaip.2024.07.010

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Abstract

Background

Type 2 low-severe asthma phenotype is often a result of corticosteroid-overtreated type 2 disease owing to persistent symptoms, often unrelated to asthma and unlikely to respond to high-dose corticosteroid treatment.

Objective

This study aimed to characterize patients with severe asthma with low eosinophil counts (<300 cells/μL) and describe their disease burden and treatment across health care settings in the United Kingdom.

Methods

A retrospective cohort study of patients with severe asthma using linked Clinical Practice Research Datalink (CPRD) Aurum-Hospital Episode Statistics (HES) and UK Severe Asthma Registry (UKSAR) data indexed patients according to the latest blood eosinophil count (BEC). Clinical characteristics, treatment patterns, outcomes, and health care resource use were described by baseline BEC (≤150 and >150 to <300 cells/μL).

Results

Analysis included 701 (CPRD-HES) and 1,546 (UKSAR) patients; 60.5% and 59.4% had BECs 150 cells/μL or less at baseline, respectively. Across BEC groups, the proportion with uncontrolled asthma (two or more exacerbations) at follow-up (12 months after the index) was 5.4% in CPRD-HES and 45.2% in UKSAR. Maintenance oral corticosteroid use remained high across BEC groups (CPRD-HES: 29.4%; UKSAR: 51.7%), symptom control remained poor (>200 μg short-acting β₂ agonist or >500 μg terbutaline/d in CPRD-HES: 48.8%; median Asthma Control Questionnaire-6 score in UKSAR: 2.0 [range, 1.0-3.3]). Health care resource use was similar across BEC groups.

Conclusions

Most patients managed in primary care experienced infrequent exacerbations, whereas UKSAR patients had frequent exacerbations. Large proportions of both patient groups had poor symptom control and continued to receive high levels of maintenance oral corticosteroids, increasing the risk of corticosteroid-induced morbidity. These data highlight the need for rigorous assessment of underlying disease pathology to guide appropriate treatment.

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嗜酸性粒细胞计数低的重症哮喘的临床和经济负担。

背景：2型(T2)低重度哮喘表型通常是皮质类固醇治疗过度的T2型疾病的结果，因为症状持续存在，通常与哮喘无关，并且不太可能对大剂量皮质类固醇治疗产生反应：本研究旨在了解嗜酸性粒细胞计数低的重症哮喘患者的特征：利用临床实践研究数据链（CPRD）Aurum-Hospital Episode Statistics（HES）和英国严重哮喘登记处（UKSAR）的相关数据对严重哮喘患者进行回顾性队列研究，根据最新的血液嗜酸性粒细胞计数（BEC）对患者进行索引。根据基线嗜酸性粒细胞计数（≤150 和 >150）描述临床特征、治疗模式、结果和医疗资源使用情况（HCRU）：分析包括 701 名（CPRD-HES）和 1546 名（UKSAR）患者；基线 BEC ≤150 cells/μl 的患者分别占 60.5%和 59.4%。在各 BEC 组中，随访时（指数后 12 个月）哮喘未得到控制（≥2 次加重）的比例在 CPRD-HES 中为 5.4%，在 UKSAR 中为 45.2%。各 BEC 组的维持性 OCS 使用率仍然较高（CPRD-HES：29.4%；UKSAR：51.7%），症状控制仍然较差（CPRD-HES >200 μg SABA 或 >500 μg 特布他林/天：48.8%；UKSAR ACQ-6 评分中位数：2.0 [1.0-3.3]）。各 BEC 组的 HCRU 相似：结论：大多数在初级医疗机构接受治疗的患者并不经常加重病情，而英国撒哈拉以南地区的患者则经常加重病情。两组患者中都有很大一部分症状控制不佳，并继续接受高水平的维持性 OCS，从而增加了皮质类固醇引起的发病风险。这些数据凸显了对潜在疾病病理进行严格评估以指导适当治疗的必要性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Allergy and Clinical Immunology-In Practice ALLERGYIMMUNOLOGY-IMMUNOLOGY

CiteScore

11.10

自引率

9.60%

发文量

683

审稿时长

50 days

期刊介绍： JACI: In Practice is an official publication of the American Academy of Allergy, Asthma & Immunology (AAAAI). It is a companion title to The Journal of Allergy and Clinical Immunology, and it aims to provide timely clinical papers, case reports, and management recommendations to clinical allergists and other physicians dealing with allergic and immunologic diseases in their practice. The mission of JACI: In Practice is to offer valid and impactful information that supports evidence-based clinical decisions in the diagnosis and management of asthma, allergies, immunologic conditions, and related diseases. This journal publishes articles on various conditions treated by allergist-immunologists, including food allergy, respiratory disorders (such as asthma, rhinitis, nasal polyps, sinusitis, cough, ABPA, and hypersensitivity pneumonitis), drug allergy, insect sting allergy, anaphylaxis, dermatologic disorders (such as atopic dermatitis, contact dermatitis, urticaria, angioedema, and HAE), immunodeficiency, autoinflammatory syndromes, eosinophilic disorders, and mast cell disorders. The focus of the journal is on providing cutting-edge clinical information that practitioners can use in their everyday practice or to acquire new knowledge and skills for the benefit of their patients. However, mechanistic or translational studies without immediate or near future clinical relevance, as well as animal studies, are not within the scope of the journal.