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Asthma burden score reflecting patient experience may improve symptom management
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Asthma is a condition in which the airways in the lungs narrow and swell and may produce extra mucus, making breathing difficult and trigger coughing, wheezing and shortness of breath. For some people, asthma is a minor nuisance. For others, it can be a major problem that interferes with daily activities and may lead to a life-threatening asthma attack. Asthma affected an estimated 262 million people in 2019 and caused 455,000 deaths, according to the World Health Organization.
There is no cure for asthma, but its symptoms can be controlled. For patients with asthma, remission is considered the primary treatment goal, with fewer or no symptoms, and the patient requiring minimal to no medication to manage their condition.
Current asthma guidelines, including those of the European Respiratory Society and the American Thoracic Society, define asthma severity based on a patient's medication dose — without taking into consideration the healthcare burden, such as how successfully patients can control their asthma, how often they visit their doctor, visit the emergency room and receive other healthcare services. In other words, what has been missing from the research behind current guidelines is data from the perspective of the patient's quality of life.
Mayo Clinic researchers propose a new, personalized approach to asthma using patient-centered information based on healthcare burden data instead of prescribed medication, according to a study published in The Lancet Respiratory Medicine.
The Mayo-led study is the first to use two longitudinal asthma cohorts from the U.S. and 11 European countries to introduce a tool that measures both asthma control and severity and translates that data into a quantifiable exacerbation – a way to measure the risk of an asthma attack.
The investigators analyzed data from 1,037 adult participants from the Severe Asthma Research Program III in the U.S. and the European Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes to calculate a composite asthma burden score based on asthma attacks and healthcare. They also added the number of instances each patient needed a rescue bronchodilator to reflect asthma symptom burden.
The lead author, Joe Zein, M.D., Ph.D., a pulmonary medicine and asthma researcher at Mayo Clinic in Arizona, says the findings show discrepancies between the current definition of asthma severity and the research team's burden score.
"The standard definition of severe asthma is based on prescribed asthma medications," says Dr. Zein. "Our personalized healthcare burden score includes patient-centered data that reflect disease severity and accurately predicts asthma remission."
Dr. Zein says the study looks at asthma remission using two well-characterized asthma cohorts. "Asthma remission has been proposed as a hypothesis. That is something we look at, but no one was analyzing the data to test it. This is the first study to test the concept of asthma remission," he says.
If further studies support the team's method of calculating asthma burden, it ultimately could help care teams better manage cases of high-risk individuals with asthma and improve their treatment.
For a complete list of authors, disclosures and funding sources, read the manuscript.
