Australian Centre for Airways disease Monitoring, The Woolcock Institute of Medical Research, Macquarie University, Sydney, New South Wales, Australia.
Ulsan University Hospital, Ulsan, Korea.
Respirology. 2024 Aug;29(8):685-693. doi: 10.1111/resp.14722. Epub 2024 May 6.
Most evidence about difficult-to-treat and severe asthma (DTTA) comes from clinical trials and registries. We aimed to identify people with DTTA from a large nationally representative asthma population and describe their characteristics and healthcare utilization compared with people whose asthma was not 'difficult-to-treat'.
We conducted a cross-sectional survey of Australians aged ≥18 years with current asthma from large web-based survey panels. Enrolment was stratified by gender, age-group and state/territory based on national population data for people with asthma. Difficult-to-treat or severe asthma was defined by poor symptom control, exacerbations and/or oral corticosteroid/biologic use despite medium/high-dose inhaled therapy. Outcomes included exacerbations, healthcare utilization, multimorbidity, quality of life and coronavirus disease of 2019 (COVID-19)-related behaviour. Weighted data were analysed using SAS version 9.4.
The survey was conducted in February-March 2021. The weighted sample comprised 6048 adults with current asthma (average age 47.3 ± SD 18.1 years, 59.9% female), with 1313 (21.7%) satisfying ≥1 DTTA criteria. Of these, 50.4% had very poorly controlled symptoms (Asthma Control Test ≤15), 36.2% were current smokers, and 85.4% had ≥1 additional chronic condition, most commonly anxiety/depression. More than twice as many participants with DTTA versus non-DTTA had ≥1 urgent general practitioner (GP) visit (61.4% vs. 27.5%, OR 4.8 [4.2-5.5, p < 0.0001]), or ≥1 emergency room visit (41.9% vs. 17.9%, OR 3.8 [3.3-4.4, p < 0.0001]) in the previous 12 months.
Our findings emphasize the burden of uncontrolled symptoms, current smoking, multimorbidity and healthcare utilization in people with DTTA in the community, who may be under-represented in registries or clinical trials.
大多数关于难治性和重度哮喘（DTTA）的证据来自临床试验和注册研究。我们旨在从大型全国代表性哮喘人群中确定难治性哮喘患者，并描述他们的特征和与非难治性哮喘患者相比的医疗保健利用情况。
我们对来自大型网络调查小组的年龄在 18 岁及以上且当前患有哮喘的澳大利亚人进行了一项横断面调查。根据全国哮喘患者的人口数据，按性别、年龄组和州/领地进行分层。难治性或重度哮喘的定义是尽管使用中/高剂量吸入治疗，但症状控制不佳、加重和/或口服皮质类固醇/生物制剂。结果包括加重、医疗保健利用、多种合并症、生活质量和 2019 年冠状病毒病（COVID-19）相关行为。使用 SAS 版本 9.4 分析加权数据。
调查于 2021 年 2 月至 3 月进行。加权样本包括 6048 名患有当前哮喘的成年人（平均年龄 47.3±18.1 岁，59.9%为女性），其中 1313 名（21.7%）符合≥1 项难治性哮喘标准。其中，50.4%的患者症状控制极差（哮喘控制测试≤15），36.2%为当前吸烟者，85.4%有≥1 种其他慢性疾病，最常见的是焦虑/抑郁。与非难治性哮喘患者相比，难治性哮喘患者有≥1 次紧急全科医生（GP）就诊的比例（61.4% vs. 27.5%，OR 4.8[4.2-5.5，p<0.0001]）或≥1 次急诊就诊（41.9% vs. 17.9%，OR 3.8[3.3-4.4，p<0.0001]）的比例更高。
我们的研究结果强调了社区中难治性哮喘患者未得到控制的症状、当前吸烟、多种合并症和医疗保健利用的负担，这些患者在注册研究或临床试验中可能代表性不足。
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