TY - JOUR

T1 - The level of diagnostic assessment in severe asthma

T2 - A nationwide real-life study

AU - von Bülow, Anna

AU - Backer, Vibeke

AU - Bodtger, Uffe

AU - Søes-Petersen, Niels Ulrik

AU - Assing, Karin Dahl

AU - Skjold, Tina

AU - Porsbjerg, Celeste

N1 - Copyright © 2017 Elsevier Ltd. All rights reserved.

PY - 2017

Y1 - 2017

N2 - INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.RESULTS: Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

AB - INTRODUCTION: Systematic assessment of patients with severe asthma is pivotal to decide which patients are eligible to new biological therapies. However, the level of diagnostic work-up in patients with severe asthma is only poorly investigated.AIMS & OBJECTIVES: To describe the diagnostic work-up in a complete population of patients with severe asthma including: objective confirmation of the asthma diagnosis, and identification of potential treatment barriers, such as poor adherence and poor inhaler technique.METHODS: A retrospective cross-sectional multicenter study was performed in 2013. We evaluated patient record forms of all patients (aged 18-65 years) consecutively referred with asthma to one of five respiratory outpatient clinics over two years. Patients were included in the study, if they fulfilled ERS/ATS guidelines for having severe asthma.RESULTS: Among 1563 patients with asthma, 98 (6.3%) patients fulfilled the criteria for having severe asthma. The diagnosis of asthma was confirmed objectively in 53/98 patients (54.1%). In total, 83.7% underwent at least one diagnostic test for asthma: reversibility test: 63.3%, PEF: 52% and bronchial challenge test: 21.4%. Among patients eligible for a bronchial challenge test (FEV1 ≥ 70%; negative PEF measurement/reversibility test), only 23.1% had such a test performed. Inhalation technique and adherence were assessed in 19.4 and 30.6% of patients, respectively.CONCLUSION: Among patients managed for severe asthma in a specialist setting, only half had the asthma diagnosis confirmed objectively, and adherence and inhaler technique were infrequently assessed.

KW - Administration, Inhalation

KW - Adolescent

KW - Adult

KW - Aged

KW - Asthma/blood

KW - Bronchial Provocation Tests/methods

KW - Cross-Sectional Studies

KW - Denmark/epidemiology

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Male

KW - Medication Adherence

KW - Middle Aged

KW - Peak Expiratory Flow Rate/physiology

KW - Respiratory Function Tests/methods

KW - Retrospective Studies

KW - Severity of Illness Index

KW - Smoking/adverse effects

KW - Young Adult

U2 - 10.1016/j.rmed.2017.01.010

DO - 10.1016/j.rmed.2017.01.010

M3 - Journal article

C2 - 28284317

VL - 124

SP - 21

EP - 29

JO - Respiratory Medicine

JF - Respiratory Medicine

SN - 0954-6111

ER -