After attending specialized centers for severe, refractory asthma, British patients had improved asthma control, decreased use of emergency health care services, reduced medication usage, and improved quality-of-life measures, according to a report published in Chest.
British researchers recently established a national registry for the approximately 5% of asthma patients who attended dedicated Difficult Asthma Services centers because of severe, refractory disease. These specialized centers perform multiple assessments to determine the cause of persistent symptoms and develop a targeted treatment approach for each patient. Alternative diagnoses are ruled out, and comorbid conditions such as allergies are identified and treated. Treatment adherence is addressed, and medications, including novel biologic agents, are tailored to each patient’s needs, said Dr. David Gibeon of Royal Brompton Hospital and the National Heart and Lung Institute, Imperial College, both in London, and his associates.
To assess the usefulness of this approach, 346 patients who were referred to these centers and enrolled in the national registry were followed for a median of 286 days (range, 100-833). More than half were found to have a contributing disorder requiring treatment, such as gastroesophageal reflux (55%) or allergies (71%).
Significantly fewer patients required an unscheduled emergency dept. or primary care visit after attending the specialized centers (66%) than they had in the preceding year (88%). Also, the average number of such visits decreased from four to one, and the percentage of patients requiring hospitalization declined significantly from 48% to 38% (Chest. 2015;148[4]:870-6).
At the same time, serum total IgE levels significantly dropped, forced expiratory volume in 1 second measures improved, and the number of courses and doses of oral corticosteroids declined. In addition, scores on two measures of asthma-related quality of life significantly improved.
This study could not address the specific reasons why the use of Difficult Asthma Services produced these improvements, and it is possible that patients’ multiple contacts with health care professionals may have exerted a placebo-type effect. Future research should examine how different components of such programs – including the treatment of comorbidities, weight loss, clinical psychological support, and asthma education – contribute to improved outcomes, Dr. Gibeon and his associates added.
The study received no funding. Dr. Gibeon reported having no relevant financial disclosures.