BACKGROUND: Approximately 30–50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid/long-acting β2-agonist (ICS/LABA) therapy. Data on prevalence and burden of uncontrolled asthma in specialty settings is lacking.
OBJECTIVE: To assess prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the US.
METHODS: 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 well-controlled 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 well-controlled 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 well-controlled 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.
CONCLUSION: 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.
