The journal of allergy and clinical immunology. In practice · 2026
Persistent Uncontrolled Severe Asthma Despite Widespread Biologic Use: Care Gaps from the French FASE2-CPHG Real-World Study.
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Portel Laurent, Nocent-Ejnaini C, Parrat E, Verdoire P, Maurer C, Goupil F, Texier N, Hervy S, Raherison-Semjen C, Morel H, Humbert M
Аннотация
BACKGROUND: Biologic therapies have transformed the management of severe asthma, yet many patients in routine care remain symptomatic. Most real-world data originate from tertiary centers and may not reflect broader health care delivery.
OBJECTIVE: To describe disease control, exacerbations, adherence, comorbidities, phenotypes, and care gaps in adults with severe asthma managed in French nonacademic hospitals in the biologic's era.
METHODS: France Asthme Sévère-Collège des Pneumologues des Centres Hospitaliers Généraux (FASE2-CPHG) was a national, multicenter, cross-sectional study conducted between 2022 and 2023 in French nonacademic hospitals. Adults with Global Initiative for Asthma 2022 Step 5 asthma were consecutively included during routine care. Physicians completed electronic case report forms and patients completed questionnaires assessing asthma control (Asthma Control Test [ACT]), adherence (Girerd score), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (Ricci-Gagnon questionnaire). Clinical characteristics, biomarkers, imaging, exacerbations, and treatments, including biologics, were recorded.
RESULTS: Among 970 patients (mean age, 54.5 ± 15.8 years; 66.3% female), 71.2% were receiving biologic therapy. Despite these treatments, 59.8% had partially controlled or uncontrolled asthma according to the ACT questionnaire. Globally, 62.6% experienced at least 1 exacerbation in the previous year. The median annual exacerbation rate was 1 (interquartile range, 0-3). Only 31.6% of patients reported full adherence, whereas 88.7% were considered adherent by physicians. Anxiety and depressive symptoms were present in 45.6% and 24.6% of patients, respectively. Biologic therapy was prescribed in 71.2% of patients, with omalizumab used in most case (41.2%). The mean duration of the ongoing treatment with biologics was 2.9 years (±5.1 years).
CONCLUSIONS: In routine nonacademic hospital practice, biologics are widely implemented, but a majority of patients remain uncontrolled. Major care gaps include unrecognized poor adherence; high psychological, metabolic, and ears, nose, and throat comorbidity burden; and incomplete optimization of inhaled therapy. Addressing these gaps may yield gains comparable to the introduction of new biologic agents.
OBJECTIVE: To describe disease control, exacerbations, adherence, comorbidities, phenotypes, and care gaps in adults with severe asthma managed in French nonacademic hospitals in the biologic's era.
METHODS: France Asthme Sévère-Collège des Pneumologues des Centres Hospitaliers Généraux (FASE2-CPHG) was a national, multicenter, cross-sectional study conducted between 2022 and 2023 in French nonacademic hospitals. Adults with Global Initiative for Asthma 2022 Step 5 asthma were consecutively included during routine care. Physicians completed electronic case report forms and patients completed questionnaires assessing asthma control (Asthma Control Test [ACT]), adherence (Girerd score), anxiety and depression (Hospital Anxiety and Depression Scale), and physical activity (Ricci-Gagnon questionnaire). Clinical characteristics, biomarkers, imaging, exacerbations, and treatments, including biologics, were recorded.
RESULTS: Among 970 patients (mean age, 54.5 ± 15.8 years; 66.3% female), 71.2% were receiving biologic therapy. Despite these treatments, 59.8% had partially controlled or uncontrolled asthma according to the ACT questionnaire. Globally, 62.6% experienced at least 1 exacerbation in the previous year. The median annual exacerbation rate was 1 (interquartile range, 0-3). Only 31.6% of patients reported full adherence, whereas 88.7% were considered adherent by physicians. Anxiety and depressive symptoms were present in 45.6% and 24.6% of patients, respectively. Biologic therapy was prescribed in 71.2% of patients, with omalizumab used in most case (41.2%). The mean duration of the ongoing treatment with biologics was 2.9 years (±5.1 years).
CONCLUSIONS: In routine nonacademic hospital practice, biologics are widely implemented, but a majority of patients remain uncontrolled. Major care gaps include unrecognized poor adherence; high psychological, metabolic, and ears, nose, and throat comorbidity burden; and incomplete optimization of inhaled therapy. Addressing these gaps may yield gains comparable to the introduction of new biologic agents.