Problems of Importance in Severe Asthma: A Patient Perspective

Abstract

Background: Despite major advances in severe asthma management, patients continue to suffer an excessive symptom burden and impaired quality of life (QoL). We sought to determine the most important problems related to severe asthma from the patients’ perspective. Methods: People (n=140) with severe refractory asthma were recruited to a cross sectional study and underwent a multidimensional assessment of their disease. As part of the assessment participants were asked “What is/are the biggest problem/s you experience as a result of your breathing problem?”. Results: Participants were predominately female (62.1%), with a mean (SD) age of 55.7 (14.7) years. They had experienced 3.1 (3.2) exacerbations in the past year, and had a mean asthma control questionnaire score (ACQ-5) of 2.0 (1.1). Patients most frequently offered dyspnoea (39.0%), limited activity (17.1%), and cough (10.3%) as their primary problem of importance. These symptoms were often presented as a cluster. At least one symptom from this cluster was reported in 51.4% of participants, 29.3% reported two and 2.9% reported all three symptoms. The self-identification of two or more of these symptoms compared to one or no symptoms, was associated with significant impairment in asthma control, ACQ-5 2.3 (1.2) vs 1.9 (1.1) p=0.04; increased depression score 6.0 (3.9) vs 4.3 (3.3) p=0.01; worse asthma QoL, AQLQ 4.4 (1.3) vs 5.1 (1.1) p=0.02, and more comorbidities, 6.7 (2.5) vs 5.6 (2.7) p=0.02. Conclusion: Dyspnoea, limited activity and cough were problems of most importance to patients with severe asthma. Few interventions have been tested in severe asthma that specifically target these symptoms, suggesting a need to develop new targeted approaches.