RT Journal Article
SR Electronic
T1 The multicomponent nature of difficult asthma
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P720
VO 42
IS Suppl 57
A1 Bernard Dyke
A1 Tasneem Rahman
A1 Vijay Joshi
A1 Veeresh Patil
A1 Christine Townshend
A1 Ramesh Kurukulaaratchy
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P720.abstract
AB Background: Difficult Asthma poses significant management challenges. Better clinical understanding of the nature of this state could facilitate better care.Aim: To aid understanding of Difficult Asthma, we characterised patients in our Adult Difficult Asthma Clinic.Methods: Retrospective data for all patients seen during a calendar year were collated including demographic factors, comorbidities, asthma severity (BTS steps), and spirometry.Results: The clinic saw 185 patients (mean age 48.2 years), who were mainly female (66.1%). Most were atopic (73.2%) with mean total IgE of 769.8. Mean FEV1 was 2.16 (68.5%) and FEV1/FVC 68.9%. Most patients were at Step 4 BTS management (57.9%), with equal proportions at Steps 5 (21.3%) and 3 (19.1%). One fifth were on maintenance prednisolone, 2.7% on oral steroid sparing agents, 4.9% on antifungal therapy and 11.0% on Omalizumab. Asthma hospital admission occurred in 25%. Comorbidities included rhinitis (80.7%), GORD (58.5%), obesity (43.2%), dysfunctional breathing (41.5%), salicylate sensitivity (32.6%), and psychological comorbidity (20.8%). Coexistent COPD was noted in 13.3% and bronchiectasis in 10.5%. Current smoking was present in 13.3%. Comorbidities were usually addressed by appropriate pharmacotherapy or behavioural therapy.Conclusion: Our Difficult Asthma population had high treatment needs but most patients were managed without need for Step 5 BTS therapy or Omalizumab and avoided hospitalisation. Our data suggest a multicomponent nature to Difficult Asthma with high prevalence of aggravating comorbidities that merit attention alongside asthma therapy. Addressing such comorbidity may offer avenues to improve the “difficult breathing syndrome” experienced by these patients.