Potential Severe Asthma Hidden in UK Primary Care

Dermot Ryan; Heath Heatley; Liam G Heaney; David J Jackson; Paul E Pfeffer; John Busby; Andrew N Menzies-Gow; Rupert Jones; Trung N Tran; Mona Al-Ahmad; Vibeke Backer; Manon Belhassen; Sinthia Bosnic-Anticevich; Arnaud Bourdin; Lakmini Bulathsinhala; Victoria Carter; Isha Chaudhry; Neva Eleangovan; J Mark FitzGerald; Peter G Gibson; Naeimeh Hosseini; Alan Kaplan; Ruth B Murray; Chin Kook Rhee; Eric Van Ganse; David B Price

doi:10.1016/j.jaip.2020.11.053

Potential Severe Asthma Hidden in UK Primary Care

Dermot Ryan, Heath Heatley, Liam G Heaney, David J Jackson, Paul E Pfeffer, John Busby, Andrew N Menzies-Gow, Rupert Jones, Trung N Tran, Mona Al-Ahmad, Vibeke Backer, Manon Belhassen, Sinthia Bosnic-Anticevich, Arnaud Bourdin, Lakmini Bulathsinhala, Victoria Carter, Isha Chaudhry, Neva Eleangovan, J Mark FitzGerald, Peter G GibsonNaeimeh Hosseini, Alan Kaplan, Ruth B Murray, Chin Kook Rhee, Eric Van Ganse, David B Price

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Abstract

BACKGROUND: Severe asthma may be underrecognized in primary care.

OBJECTIVE: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care.

METHODS: This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared.

RESULTS: Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA.

CONCLUSIONS: Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.

Original language	English
Pages (from-to)	1612-1623.e9
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	9
Issue number	4
Early online date	09 Dec 2020
DOIs	https://doi.org/10.1016/j.jaip.2020.11.053
Publication status	Published - Apr 2021

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Potential Severe Asthma Hidden in UK Primary Care
Copyright 2020 the authors. This is an open access article published under a Creative Commons Attribution-NonCommercial-NoDerivs License (https://creativecommons.org/licenses/by-nc-nd/4.0/), which permits distribution and reproduction for non-commercial purposes, provided the author and source are cited.
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Ryan, D., Heatley, H., Heaney, L. G., Jackson, D. J., Pfeffer, P. E., Busby, J., Menzies-Gow, A. N., Jones, R., Tran, T. N., Al-Ahmad, M., Backer, V., Belhassen, M., Bosnic-Anticevich, S., Bourdin, A., Bulathsinhala, L., Carter, V., Chaudhry, I., Eleangovan, N., FitzGerald, J. M., ... Price, D. B. (2021). Potential Severe Asthma Hidden in UK Primary Care. The Journal of Allergy and Clinical Immunology: In Practice, 9(4), 1612-1623.e9. https://doi.org/10.1016/j.jaip.2020.11.053

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title = "Potential Severe Asthma Hidden in UK Primary Care",

abstract = "BACKGROUND: Severe asthma may be underrecognized in primary care.OBJECTIVE: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care.METHODS: This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared.RESULTS: Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA.CONCLUSIONS: Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.",

author = "Dermot Ryan and Heath Heatley and Heaney, {Liam G} and Jackson, {David J} and Pfeffer, {Paul E} and John Busby and Menzies-Gow, {Andrew N} and Rupert Jones and Tran, {Trung N} and Mona Al-Ahmad and Vibeke Backer and Manon Belhassen and Sinthia Bosnic-Anticevich and Arnaud Bourdin and Lakmini Bulathsinhala and Victoria Carter and Isha Chaudhry and Neva Eleangovan and FitzGerald, {J Mark} and Gibson, {Peter G} and Naeimeh Hosseini and Alan Kaplan and Murray, {Ruth B} and Rhee, {Chin Kook} and {Van Ganse}, Eric and Price, {David B}",

year = "2021",

month = apr,

doi = "10.1016/j.jaip.2020.11.053",

language = "English",

volume = "9",

pages = "1612--1623.e9",

journal = "The Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2201",

publisher = "American Academy of Allergy, Asthma and Immunology",

number = "4",

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Ryan, D, Heatley, H, Heaney, LG, Jackson, DJ, Pfeffer, PE, Busby, J, Menzies-Gow, AN, Jones, R, Tran, TN, Al-Ahmad, M, Backer, V, Belhassen, M, Bosnic-Anticevich, S, Bourdin, A, Bulathsinhala, L, Carter, V, Chaudhry, I, Eleangovan, N, FitzGerald, JM, Gibson, PG, Hosseini, N, Kaplan, A, Murray, RB, Rhee, CK, Van Ganse, E & Price, DB 2021, 'Potential Severe Asthma Hidden in UK Primary Care', The Journal of Allergy and Clinical Immunology: In Practice, vol. 9, no. 4, pp. 1612-1623.e9. https://doi.org/10.1016/j.jaip.2020.11.053

TY - JOUR

T1 - Potential Severe Asthma Hidden in UK Primary Care

AU - Ryan, Dermot

AU - Heatley, Heath

AU - Heaney, Liam G

AU - Jackson, David J

AU - Pfeffer, Paul E

AU - Busby, John

AU - Menzies-Gow, Andrew N

AU - Jones, Rupert

AU - Tran, Trung N

AU - Al-Ahmad, Mona

AU - Backer, Vibeke

AU - Belhassen, Manon

AU - Bosnic-Anticevich, Sinthia

AU - Bourdin, Arnaud

AU - Bulathsinhala, Lakmini

AU - Carter, Victoria

AU - Chaudhry, Isha

AU - Eleangovan, Neva

AU - FitzGerald, J Mark

AU - Gibson, Peter G

AU - Hosseini, Naeimeh

AU - Kaplan, Alan

AU - Murray, Ruth B

AU - Rhee, Chin Kook

AU - Van Ganse, Eric

AU - Price, David B

PY - 2021/4

Y1 - 2021/4

N2 - BACKGROUND: Severe asthma may be underrecognized in primary care.OBJECTIVE: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care.METHODS: This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared.RESULTS: Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA.CONCLUSIONS: Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.

AB - BACKGROUND: Severe asthma may be underrecognized in primary care.OBJECTIVE: Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care.METHODS: This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared.RESULTS: Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β2-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV1/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β2-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA.CONCLUSIONS: Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.

U2 - 10.1016/j.jaip.2020.11.053

DO - 10.1016/j.jaip.2020.11.053

M3 - Article

C2 - 33309935

SN - 2213-2201

VL - 9

SP - 1612-1623.e9

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

IS - 4

ER -

Potential Severe Asthma Hidden in UK Primary Care

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