Abstract
Introduction: Severe asthma is a heterogeneous disease that causes significant disease burden, is often refractory to treatment and is associated with comorbidities that confound management. Multidimensional assessment (MDA) followed by targeted therapy has been proposed as a superior treatment approach. We tested the hypothesis that MDA and targeted therapy in severe asthma would lead to improved control measured by the asthma control questionnaire (ACQ5).
Methods: A RCT of MDA and targeted therapy (intervention group, IG) versus usual severe asthma care (UC) was conducted. Participants with severe asthma (n=55) underwent a baseline MDA and 16 week follow up. The intervention involved individualised therapies tailored to traits of the airway, comorbidities, risk-factors and self-management, delivered via case-management. The UC arm received evidence-based treatment within a severe asthma clinic.
Results: Twenty-eight participants were randomised to IG and 27 to UC; 65.5% were female, with a mean (SD) age of 52.2 (13.9) years and post-bronchodilator FEV1 was 73.0% (21.2) predicted. The intervention resulted in significant improvements in asthma control compared to UC; mean difference (SE) in ACQ5 post IG -0.62 (0.18) compared to 0.07 (0.19) for UC, p=0.01, and health status p=0.001. Sputum eosinophils (%) increased in the UC 8.20 (3.49) compared to -2.52 (3.73) for IG, p=0.04. There was also a significant reduction in IG CRP; -4.90 (1.42) compared to UC 0.61 (1.36), p=0.01.
Conclusion: Management of severe asthma based on multidimensional assessment followed by targeted therapy results in significant improvements. This study supports precision-based medicine in severe asthma.
- Copyright ©the authors 2017
