Very poorly controlled asthma prevalent after 10 years of treatment

by Bruce Sylvester: Persistent, very poorly controlled (VPC) disease remains highly prevalent after 10 years of standard treatment among patients with severe or difficult-to-treat asthma, researchers reported on May 14, 2016 at the American Thoracic Society annual meeting.

“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,” said lead investigator Tmirah Haselkorn, PhD, of EpiMetrix in Los Altos, California.

The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens follow-up study (TENOR II) evaluated the prevalence of persistent VPC asthma in subjects more than 10 years after the end of the TENOR I study.

TENOR II investigators enrolled 341 subjects, with 327 becoming evaluable. TENOR II was a multicenter, observational study with a single follow-up visit in 2014.

The researchers categorized subjects’ asthma using National Heart, Lung, and Blood Institute asthma guidelines. They defined persistent VPC asthma as manifestation of VPC asthma at both TENOR I and TENOR II enrollment examinations visits. A comparator cohort showed well or not well-controlled asthma at either enrollment examination.

Of the 327 evaluable TENOR II patients. 48.0% (n=157) showed persistent VPC asthma.

Subjects with persistent VPC also showed higher levels of comorbidities compared to  non-persistent VPC asthma patients, including gastroesophagael reflux disease (52.2% versus 41.2%, respectively).

Persistent VPC patients were more than three times as likely to have needed hospitalization/emergency department visit for exacerbations requiring corticosteroids in the prior 12 months (29.7% versus 9.0% respectively).

About 25% of subjects with persistent VPC asthma had not used a combined inhaled corticosteroid/long-acting beta2-agonist medication in the prior six months, and only 12.7% had used omalizumab.

Certain variables evaluated during TENOR I enrollment became significantly predictive of persistent VPC asthma — black race, current or past smoking status, corticosteroid course for worsening asthma in the previous three months and decreased post-bronchodilator forced expiratory flow in 1 second (FEV1) .

The authors concluded that when patients manifest the variables associated with a greater risk for VPC, physicians should focus care on intensive management of modifiable factors, like smoking and lung function, as well as improving medication adherence or alternative treatment strategies.