Mild Asthma and Life-Threatening Exacerbations: Is it Time to Take Action?

Spanish multidisciplinary consensus on the characteristics of severe asthma patients on biologic treatment who are candidates for at-home administration

BACKGROUND AND OBJECTIVE

Biologic therapies are known to reduce exacerbations and improve severe uncontrolled asthma management. The at-home administration of biologics has increased during the COVID-19 pandemic, but the characteristics of severe uncontrolled asthma patients who may benefit from at-home administration of biologic therapy have yet to be identified.

MATERIALS AND METHODS

This project is based on the Delphi method, designed to reach an expert consensus through a multidisciplinary scientific committee addressing the following questions: clinical characteristics, treatment adherence, patient or caregiver administration ability, patient self-care, relationship with the healthcare professional, patient preference, and access to the hospital.

RESULTS

One hundred and thirty-one healthcare professionals (pulmonologists, allergists, nurses, and hospital pharmacists) completed two Delphi consensus questionnaires. Fourteen items were identified as priority characteristics, the first five being: 1. The patient follows the healthcare team's indications/recommendations to control their disease, 2. The patient is capable of detecting any deterioration in their disease and of identifying exacerbation triggers, 3. The patient receives biologic therapy and has stable disease with no vital risk, 4. The patient takes responsibility for their self-care, 5. The patient has occupational/educational obligations that prevent them from going to the hospital regularly.

CONCLUSION

Disease stability and control plus the ability to identify exacerbation triggers are the most important characteristics when opting for at-home administration for a patient with severe uncontrolled asthma on biologic therapy. These recommendations could be applicable in clinical practice.

Monoclonal antibody treatment for severe uncontrolled asthma in Spain: analytical map

BACKGROUND

Monoclonal antibodies (mABs) have become available to treat more efficiently patients with severe uncontrolled asthma (SUA). However, the use of mABs is lower than expected given the prevalence of SUA, with significant disparities in the use of these treatments.

OBJECTIVE

To evaluate the proportion of patients with SUA treated with mABs in Spain, and to analyze some of the factors that could determine these prescription patterns.

METHODS

An analysis was performed on the data provided from the Hospitals National Health System (NHS) 2018 catalogue where Chest Diseases Department and a Hospital Pharmacy were available. Random sampling was performed to determine the sample size, stratifying proportionally by geographic area and hospital level. Characteristics of the participating sites, as well as the prescribing of mABs were collected, which included geographic area, hospital levels, prescribing medical specialities, types of clinics, and mABs prescribed.

RESULTS

Data from 90 hospitals were analyzed (Response rate 64.3%). Level 4 hospitals, the Canary Islands geographical area, and the presence of a high complexity Asthma Healthcare Unit (ACU) were associated with a higher probability that the SUA was treated with mABs.

CONCLUSION

The map of the prescribing of mABs for SUA in Spain shows a significant variation by geographic area, hospital level, type of clinic, and the accreditation level of the ACUs. At the current time, there appears to be significant under-prescribing of these treatments.

Predicting the requiring intubation and invasive mechanical ventilation among asthmatic exacerbation-related hospitalizations

OBJECTIVE

To identify the predictors of requiring intubation and invasive mechanical ventilation (IMV) in asthmatic exacerbation (AE)-related hospitalizations.

METHODS

This study was conducted in southern Thailand between October 2016 and September 2018. The characteristics and clinical findings of patients admitted for AE requiring intubation and IMV were analyzed. The variables were evaluated by univariate and multivariate analysis to identify the independent predictors.

RESULTS

A total of 509 patients with a median age of 53 years were included in the study. Being female (60.2%), having no previous use of a controller (64.5%), having a history of smoking, and having a high level of white blood cell count (14,820 cells/mm³) were the significantly more common characteristics of the patients requiring mechanical ventilation. Univariate analysis showed that being male (OR = 1.96 95% CI, 1.22-3.13), having a history of 1-2 AEs in the past 12 months (OR = 3.27 95% CI, 1.75-6.12), and having an absolute eosinophil count ≥300 cells/mm³ (OR = 1.68 95% CI, 1.05-2.69) were associated with patients requiring IMV, whereas the patients who were taking a reliever (OR = 0.36 95% CI, 0.23-0.57) and controller (OR = 0.42 95% CI, 0.27-0.68) were associated with a decreased risk of requiring intubation and IMV. In multivariate analysis, only 1-2 AEs within the past 12 months (OR = 3.12, 95% CI, 1.19-8.21) was an independent predictor of requiring intubation and IMV in patients with AE-related hospitalization (p = 0.021).

CONCLUSIONS

This study found that a history of 1-2 AEs in the past 12 months was a strong independent predictor for the requirement of intubation and IMV in patients hospitalized for AE-related conditions.