Development of an asthma health-care burden score as a measure of severity and predictor of remission in SARP III and U-BIOPRED: results from two major longitudinal asthma cohorts.
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Zein Joe G, Zounemat-Kerman Nazanin, Adcock Ian M, Hu Bo, Attaway Amy, Castro Mario, Dahlén Sven-Erik, Denlinger Loren C, Erzurum Serpil C, Fahy John V, Gaston Benjamin, Hastie Annette T, Israel Elliot, Jarjour Nizar N, Levy Bruce D, Mauger David T, Moore Wendy, Peters Michael C, Sumino Kaharu, Townsend Elizabeth, Woodruff Prescott, Ortega Victor E, Wenzel Sally E, Meyers Deborah A, Chung Kian Fan, Bleecker Eugene R, Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED) Consortium and the the US National Heart, Lung, and Blood Institute Severe Asthma Research Program (SARP III)
Аннотация
METHODS: We analysed prospectively collected data from the Severe Asthma Research Program III (SARP III; USA) and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED; 11 European countries) to calculate a composite burden score based on asthma exacerbations and health-care utilisation, which was modified to include the use of short-acting beta agonists (SABAs) to reflect asthma symptom burden.
FINDINGS: In SARP III, 528 adult participants with asthma were followed up for a mean of 4·4 (SD 1·6) years, and 312 (59%) had severe asthma according to the ERS-ATS definition. Among the 205 participants with asthma who used rescue SABAs daily, 90 used these two or more times a day. In U-BIOPRED, 509 adult participants with asthma were followed up for 1 year, and 421 (83%) had severe asthma. The burden score was less than 1·29 per patient-year in 106 (34%) of 312 SARP III participants and in 80 (19%) of 421 U-BIOPRED participants with severe asthma. By contrast, the burden score was above the median value in 58 (28%) SARP III and 24 (27%) U-BIOPRED participants with non-severe asthma. In both cohorts, the burden score negatively correlated with lung function, asthma control, and quality of life. A burden score of 0·15 or lower predicted asthma remission with a sensitivity greater than 91% and a specificity of 99%.
INTERPRETATION: Our findings highlight considerable discrepancies between the current definition of asthma severity and our burden score. Although the definition of severe asthma proposed by the ERS-ATS and the and Global Initiative for Asthma (GINA) is based on prescribed asthma medications, our personalised health-care burden score includes patient-centred data that reflect disease severity and accurately predicts asthma remission. Subject to prospective validation, the burden score could help to optimise the management of high-risk individuals with asthma.
FUNDING: SARP III: US National Heart, Lung, and Blood Institute; AstraZeneca; Boehringer Ingelheim; Genentech; GlaxoSmithKline; Sanofi Genzyme/Regeneron; and Teva Pharmaceuticals.
U-BIOPRED: Innovative Medicines Initiative Joint Undertaking (EU's Seventh Framework Programme and European Federation of Pharmaceutical Industries and Associations) and eTRIKS project.