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Very poorly controlled asthma may persist for more than a decade despite treatment
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Almost half of patients with severe or difficult-to-treat asthma in the TENOR II cohort still had symptoms of very poorly controlled asthma following more than a decade of treatment, according to data presented at the annual American Thoracic Society International Conference.
Tmirah Haselkorn, PhD, of EpiMetrix in Los Altos, California, and colleagues also reported that the risk of persistent very poorly controlled asthma was associated with several clinical and demographic factors.
TENOR II was a multicenter, observational study with a single, cross-sectional follow-up visit that assessed the prevalence of persistent very poorly controlled asthma more than 10 years after the TENOR I study. TENOR II included 341 patients and 327 patients had an available level of asthma control for both time points.
The researchers classified patients' asthma using National Heart, Lung, and Blood Institute asthma guidelines.
"Persistent [very poorly controlled] asthma was defined as having [very poorly controlled] asthma at both TENOR I and TENOR II enrollment visits; the comparison group had well or not well controlled asthma at either visits," Haselkorn and colleagues wrote in their abstract.
They reported that 48% of patients had persistent very poorly controlled asthma. Those patients, when compared with patients without persistent very poorly controlled asthma, had higher levels of comorbidities, including gastroesophageal reflux disease (52.2% vs. 41.2%).
In addition, patients with persistent very poorly controlled asthma had reduced lung function and were more likely to require hospitalization or an ED visit for exacerbations that required corticosteroids in the previous 12 months (29.7% vs. 9%).
Haselkorn and colleagues also found lower pre-bronchodilator percent predicted FEV1 (62.5% vs. 82.1%) and post-bronchodilator percent predicted FEV1 (69.1% vs. 86.5%) in patients with persistent very poorly controlled asthma vs. patients without. Patients with persistent very poorly controlled asthma also had higher total IgE geometric mean compared with patients without (89.3 vs. 55.7).
Patients with persistent very poorly controlled asthma were more likely to be black, have current or past smoking status, have decreased FEV1 percent predicted post-bronchodilator and have taken corticosteroids for worsening asthma in the previous 3 months.
"Despite treatment with standard of care therapy, persistent [very poorly controlled] asthma was highly prevalent after >10 years in patients with severe or difficult-to-treat asthma," the researchers concluded in their abstract. "These patients demonstrated higher disease burden, compromised lung function, and higher total and specific IgE levels than patients with non-persistent [very poorly controlled] asthma. Several demographic and clinical factors were predictive of persistent [very poorly controlled] outcome and their presence should direct more intensive management of modifiable factors."
According to a press release issued by the American Thoracic Society, Haselkorn and colleagues recommend focusing on managing smoking and lung function in addition to alternative treatment strategies or medication adherence. – by Chelsea Frajerman Pardes
Reference:
Haselkorn T, et al. Prevalence and risk factors for persistent very poorly controlled asthma after more than a decade in the TENOR II cohort. Presented at: American Thoracic Society International Conference, May 13-18, 2016; San Francisco.
Disclosures: Healio Internal Medicine could not confirm disclosures at the time of publication.