High Rates of Very Poorly Controlled Asthma Found

A new study found that 48% of patients with severe or difficult-to-treat asthma still had very poorly controlled (VPC) symptoms after more than a decade of treatment in the TENOR II study.

The TENOR II study was a 10-year follow up to TENOR I and included 341 patients with severe or difficult-to-treat asthma. There were 327 patients with an avail level of asthma control for both TENOR I and TENOR II studies.

"Persistent VPC asthma was defined as having VPC asthma at both TENOR I and TENOR II enrollment visits; the comparison group had well or not well-controlled asthma at either visit," said lead investigator Tmirah Haselkorn, PhD.

According to the study, presented at the ATS 2016 International Conference, asthma is considered well-controlled if symptoms happen 2 times per week or less, rescue medication is used 2 times per week or less, there is no early morning or nocturnal waking, no limitations on activities, the patient and/or doctor considers it to be well-controlled, and the patient’s peak expiratory flow is normal of personal best FEV1.

Researchers found that 48% of patients had persistent VPC asthma and had increased levels of comorbidities compared with non-persistent VPC asthma patients. Gastroesophageal disease occurred in 52.2% of persistent VPC asthma patients and 41.2% in non-VPC asthma patients.

Researchers also discovered that in the previous 12 months, persistent VPC asthma patients had a decreased lung function and were 3 times more likely to be hospitalized or visit the emergency department for exacerbations that needed corticosteroids than non-VPC asthma patients, according to the study.

Approximately 25% of patients with persistent VPC asthma had not used corticosteroid/long-acting beta2-agonist medication in the previous 6 months, while 12.7% used omalizumab in that time period.

According to the study, black race, current or past smoking status, corticosteroid course for worsening asthma in the 3 previous months, and decreased FEV1 all predicated persistent VPC.

"Patients with persistent VPC asthma demonstrated higher disease burden, compromised lung function, and higher total and specific immunoglobin E levels than patients with non-persistent VPC asthma," Dr Haselkorn said.

Medication data suggests that patients may be undertreated and could also be non-compliant.

Researchers concluded that physicians should give more intensive management of modifiable risk factors such as smoking, medication adherence, and alternative treatment to patients who have the variables associated with a greater risk for persistent VPC asthma.