Single Visit to Severe Asthma Center Produced Long-term Improvements for Many with Uncontrolled Asthma

In most patients, asthma can be controlled by inhaled corticosteroids and bronchodilators. However, many patients remain symptomatic and have a poor quality of life (QOL) despite maximal treatment. This subgroup also uses healthcare resources extensively and is responsible for high healthcare costs.

Recent prospective data from the United Kingdom showed that managing patients with uncontrolled asthma at a dedicated severe asthma center improved QOL and decreased use of healthcare resources. These findings indicate that patients with uncontrolled asthma may benefit from management by a specialized team. However, it was unknown whether or not one-time evaluation by a team of asthma experts, with no long-term supervision, could enhance outcomes.

To determine the effectiveness of a one-day visit to a severe asthma center in patients with uncontrolled asthma, a Dutch team evaluated asthma control, QOL, and use of healthcare resources both before and 1 year after a visit to their specialized asthma center. The visit included an extensive multidisciplinary assessment that consisted of questionnaires, allergy tests, spirometry, induced sputum and blood cell counts, psychological evaluation, and measurement of 6-minute walking distance.

After assessment, 83% of patients returned to their pulmonologist with a personalized asthma management plan for implementation. Only seven patients received treatment at the center that was not available at their local hospital.

The study enrolled 40 non-smoking patients with uncontrolled asthma who were referred to the center by their pulmonologists from June 2013 to June 2014. Results of the study were published in a recent issue of European Respiratory Journal.

Questionnaire results indicated that, 1 year after the visit, asthma control improved (P = 0.003) and asthma-related QOL increased significantly (P < 0.001).

The team also found a significant decrease in the percentage of patients who reported ≥2 exacerbations of asthma or ≥1 emergency department (ED) visits in the previous year (P < 0.001 for both). A significant decrease was also found in the percentage of patients who reported hospital admission in the previous year (P = 0.001).

The investigators noted that the greatest improvements in asthma control and reductions in exacerbation were found in those with higher sputum eosinophil counts at baseline. Although all groups seemed to benefit from the intervention, those with eosinophilic airway inflammation appeared to benefit the most.

After 12 months of follow-up, 15% of patients were being treated with omalizumab (Xolair/Genentech-Novartis), and 13% were participating in a trial of an anti-interleukin 5 agent. Because both of these agents are associated with less frequent exacerbations and better QOL, the investigators speculated that their use may have accounted for some of the improvement in outcomes after the intervention. They further speculated that, in patients who were ineligible to receive these agents, targeting corticosteroid therapy to those with eosinophilic inflammation may have also helped to improve outcomes.

The investigators concluded that the cost of the intervention seemed justified by the benefits it produced. They added that because the intervention helped to distinguish patients with truly severe asthma from those with merely uncontrolled asthma, it could reduce dependence on expensive biological treatments and long-term management in specialized centers.