The level of diagnostic assessment in severe asthma: A nationwide real-life study

Anna von Bülow; Vibeke Backer; Uffe Bodtger; Niels Ulrik Søes-Petersen; Karin Dahl Assing; Tina Skjold; Celeste Porsbjerg

doi:10.1016/j.rmed.2017.01.010

The level of diagnostic assessment in severe asthma: A nationwide real-life study

Anna von Bülow, Vibeke Backer, Uffe Bodtger, Niels Ulrik Søes-Petersen, Karin Dahl Assing, Tina Skjold, Celeste Porsbjerg

Department of Clinical Medicine

13 Citations (Scopus)

Abstract

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.

Original language	English
Journal	Respiratory Medicine
Volume	124
Pages (from-to)	21-29
ISSN	0954-6111
DOIs	https://doi.org/10.1016/j.rmed.2017.01.010
Publication status	Published - 1 Mar 2017

Keywords

Administration, Inhalation
Adolescent
Adult
Aged
Asthma/blood
Bronchial Provocation Tests/methods
Cross-Sectional Studies
Denmark/epidemiology
Female
Hospitalization/statistics & numerical data
Humans
Male
Medication Adherence
Middle Aged
Peak Expiratory Flow Rate/physiology
Respiratory Function Tests/methods
Retrospective Studies
Severity of Illness Index
Smoking/adverse effects
Young Adult

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10.1016/j.rmed.2017.01.010

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title = "The level of diagnostic assessment in severe asthma: A nationwide real-life study",

abstract = "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.",

keywords = "Administration, Inhalation, Adolescent, Adult, Aged, Asthma/blood, Bronchial Provocation Tests/methods, Cross-Sectional Studies, Denmark/epidemiology, Female, Hospitalization/statistics & numerical data, Humans, Male, Medication Adherence, Middle Aged, Peak Expiratory Flow Rate/physiology, Respiratory Function Tests/methods, Retrospective Studies, Severity of Illness Index, Smoking/adverse effects, Young Adult",

author = "{von B{\"u}low}, Anna and Vibeke Backer and Uffe Bodtger and S{\o}es-Petersen, {Niels Ulrik} and Assing, {Karin Dahl} and Tina Skjold and Celeste Porsbjerg",

year = "2017",

month = mar,

day = "1",

doi = "10.1016/j.rmed.2017.01.010",

language = "English",

volume = "124",

pages = "21--29",

journal = "Respiratory Medicine",

issn = "0954-6111",

publisher = "Elsevier",

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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

PY - 2017/3/1

Y1 - 2017/3/1

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

SN - 0954-6111

VL - 124

SP - 21

EP - 29

JO - Respiratory Medicine

JF - Respiratory Medicine

ER -

The level of diagnostic assessment in severe asthma: A nationwide real-life study

Abstract

Keywords

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