Centre for Public Health, School of Medicine, Dentistry and Biomedical Sciences, Queen's University Belfast, Belfast, United Kingdom.
Medical and Scientific Affairs, AstraZeneca UK, London, United Kingdom.
J Allergy Clin Immunol Pract. 2024 Oct;12(10):2785-2797. doi: 10.1016/j.jaip.2024.07.010. Epub 2024 Jul 18.
Type 2 low-severe asthma phenotype is often a result of corticosteroid-overtreated type 2 disease owing to persistent symptoms, often unrelated to asthma and unlikely to respond to high-dose corticosteroid treatment.
This study aimed to characterize patients with severe asthma with low eosinophil counts (<300 cells/μL) and describe their disease burden and treatment across health care settings in the United Kingdom.
A retrospective cohort study of patients with severe asthma using linked Clinical Practice Research Datalink (CPRD) Aurum-Hospital Episode Statistics (HES) and UK Severe Asthma Registry (UKSAR) data indexed patients according to the latest blood eosinophil count (BEC). Clinical characteristics, treatment patterns, outcomes, and health care resource use were described by baseline BEC (≤150 and >150 to <300 cells/μL).
Analysis included 701 (CPRD-HES) and 1,546 (UKSAR) patients; 60.5% and 59.4% had BECs 150 cells/μL or less at baseline, respectively. Across BEC groups, the proportion with uncontrolled asthma (two or more exacerbations) at follow-up (12 months after the index) was 5.4% in CPRD-HES and 45.2% in UKSAR. Maintenance oral corticosteroid use remained high across BEC groups (CPRD-HES: 29.4%; UKSAR: 51.7%), symptom control remained poor (>200 μg short-acting β agonist or >500 μg terbutaline/d in CPRD-HES: 48.8%; median Asthma Control Questionnaire-6 score in UKSAR: 2.0 [range, 1.0-3.3]). Health care resource use was similar across BEC groups.
Most patients managed in primary care experienced infrequent exacerbations, whereas UKSAR patients had frequent exacerbations. Large proportions of both patient groups had poor symptom control and continued to receive high levels of maintenance oral corticosteroids, increasing the risk of corticosteroid-induced morbidity. These data highlight the need for rigorous assessment of underlying disease pathology to guide appropriate treatment.
2 型低严重度哮喘表型通常是由于持续存在的症状而导致的皮质类固醇过度治疗的 2 型疾病的结果，这些症状通常与哮喘无关，并且不太可能对高剂量皮质类固醇治疗产生反应。
本研究旨在描述英国医疗保健环境中严重哮喘伴低嗜酸性粒细胞计数（<300 个/μL）患者的特征，并描述其疾病负担和治疗情况。
使用链接的临床实践研究数据库（CPRD） Aurum-医院入院统计（HES）和英国严重哮喘登记处（UKSAR）数据对严重哮喘患者进行回顾性队列研究，根据最新的嗜酸性粒细胞计数（BEC）对患者进行索引。根据基线时的 BEC（≤150 和>150 至<300 个/μL）描述了临床特征、治疗模式、结局和卫生保健资源利用情况。
分析纳入了 701 名（CPRD-HES）和 1546 名（UKSAR）患者；60.5%和 59.4%的患者基线时的 BEC 为 150 个/μL 或更低。在 BEC 组中，随访（索引后 12 个月）时哮喘控制不佳（两次或更多次加重）的比例分别为 CPRD-HES 组的 5.4%和 UKSAR 组的 45.2%。在整个 BEC 组中，维持口服皮质类固醇的使用仍然很高（CPRD-HES 组：29.4%；UKSAR 组：51.7%），症状控制仍然很差（CPRD-HES 组：>200μg 短效β激动剂或>500μg 特布他林/d：48.8%；UKSAR 组：中位数哮喘控制问卷-6 评分：2.0[范围，1.0-3.3]）。BEC 组之间的卫生保健资源使用相似。
大多数在初级保健中管理的患者经历了不频繁的加重，而 UKSAR 患者则经历了频繁的加重。两个患者组都有很大比例的症状控制不佳，并且继续接受高水平的维持口服皮质类固醇治疗，增加了皮质类固醇引起的发病率的风险。这些数据突出表明需要严格评估潜在的疾病病理以指导适当的治疗。
