Abstract
Introduction The benefits of specialist assessment and management have yet to be evaluated within the biologic era of UK severe asthma treatment, and potential disparities have not been considered.
Methods In an uncontrolled before-and-after study, we compared asthma symptoms (asthma control questionnaire [ACQ6]), exacerbations, unscheduled secondary care use, lung function (FEV1) and oral corticosteroid (OCS) dose after one year. We compared outcomes by sex, age (18–34, 35–49, 50–64, 65+ years), ethnicity (Caucasian versus Non- Caucasian) and hospital site after adjusting for demographics and variation in biologic therapy use.
Results 1,140 patients were followed-up for 1,370 person-years from twelve specialist centres. At annual review, ACQ6 score was reduced by a median of 0.7 (IQR:0.0, 1.5), exacerbations by 75% (IQR: 33%, 100%) and unscheduled secondary care by 100% (IQR:67%, 100%). FEV1 increased by a median of 20 mL (IQR:-200, 340) while OCS dose decreased for 67% of patients. Clinically meaningful improvements occurred across almost all patients, including those not receiving biologic therapy. There was little evidence of differences across demographic groups, although those aged over 65 demonstrated larger reductions in exacerbations (69% versus 52%; p<0.001) and unscheduled care use (77% versus 50%; p<0.001) compared to patients aged under 34 years. There were more than 2-fold differences between the best and worst performing centres across all study outcomes.
Conclusions Specialist assessment and management is associated with substantially improved patient outcomes which are broadly consistent across demographic groups, and are not restricted to those receiving biologic therapy. Significant variation exists between hospitals which requires further investigation.
Footnotes
This manuscript has recently been accepted for publication in the European Respiratory Journal. It is published here in its accepted form prior to copyediting and typesetting by our production team. After these production processes are complete and the authors have approved the resulting proofs, the article will move to the latest issue of the ERJ online. Please open or download the PDF to view this article.
Conflict of Interest: CR & JB declare no competing interests.
Conflict of Interest: LGH is Academic Lead for the Medical Research Council Stratified Medicine UK Consortium in Severe Asthma which involves industrial partnerships with a number of pharmaceutical companies.
Conflict of Interest: AMG has consultancy agreements with Astra Zeneca and Sanofi, he is participating in research funded by Astra Zeneca, he has received lecture fees from Teva, Astra Zeneca, Novartis and Sanofi attended advisory boards for Novartis, Sanofi, Glaxo SmithKline, Astra Zeneca and Teva and attended international conferences with Teva.
Conflict of Interest: DJJ has received advisory board and speaker fees from AstraZeneca plc, Boehringer Ingelheim, Chiesi Farmaceutici, GlaxoSmithKline plc, Napp Pharmaceuticals Limited, Novartis International.
Conflict of Interest: PEP has attended advisory board for AstraZeneca, GlaxoSmithKline and Sanofi; has given lectures at meetings with/without lecture honoraria supported by AstraZeneca and GlaxoSmithKline; has taken part in clinical trials sponsored by AstraZeneca, GlaxoSmithKline and Novartis; and is conducting research funded by GlaxoSmithKline for which his institution receives remuneration.
Conflict of Interest: RC has received lecture fees from GSK, AstraZeneca, Teva, Chiesi, Sanofi and Novartis; honoraria for Advisory Board Meetings from GSK, AstraZeneca, Teva, Chiesi, Novartis; sponsorship to attend international scientific meetings from Chiesi, Napp, Sanofi and GSK and a research grant to her Institute from AstraZeneca for a UK multi-centre study.
This is a PDF-only article. Please click on the PDF link above to read it.
- Received March 28, 2022.
- Accepted June 23, 2022.
- Copyright ©The authors 2022.
This version is distributed under the terms of the Creative Commons Attribution Licence 4.0.