Factors associated with uncontrolled severe asthma in the biologic era

Hideki Yasui; Kyohei Oishi; Fumiya Nihashi; Kazuki Furuhashi; Tomoyuki Fujisawa; Yusuke Inoue; Masato Karayama; Hironao Hozumi; Yuzo Suzuki; Noriyuki Enomoto; Suguru Kojima; Mitsuru Niwa; Masanori Harada; Masato Kato; Dai Hashimoto; Koshi Yokomura; Naoki Koshimizu; Mikio Toyoshima; Masahiro Shirai; Toshihiro Shirai; Naoki Inui; Takafumi Suda

doi:10.1016/j.rmed.2024.107881

Factors associated with uncontrolled severe asthma in the biologic era

Respir Med. 2024 Nov 22:236:107881. doi: 10.1016/j.rmed.2024.107881. Online ahead of print.

Authors

Hideki Yasui¹, Kyohei Oishi², Fumiya Nihashi³, Kazuki Furuhashi⁴, Tomoyuki Fujisawa⁵, Yusuke Inoue⁶, Masato Karayama⁷, Hironao Hozumi⁸, Yuzo Suzuki⁹, Noriyuki Enomoto¹⁰, Suguru Kojima¹¹, Mitsuru Niwa¹², Masanori Harada¹³, Masato Kato¹⁴, Dai Hashimoto¹⁵, Koshi Yokomura¹⁶, Naoki Koshimizu¹⁷, Mikio Toyoshima¹⁸, Masahiro Shirai¹⁹, Toshihiro Shirai²⁰, Naoki Inui²¹, Takafumi Suda²²

Affiliations

¹ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Center for Clinical Research, Hamamatsu University Hospital, Hamamatsu, Japan. Electronic address: [email protected].
² Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
³ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. Electronic address: [email protected].
⁴ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
⁵ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
⁶ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
⁷ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
⁸ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
⁹ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
¹⁰ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
¹¹ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Department of Respiratory Medicine, Shizuoka City Shizuoka Hospital, Shizuoka, Japan. Electronic address: [email protected].
¹² Department of Respiratory Medicine, Hamamatsu Medical Center, Hamamatsu, Japan. Electronic address: [email protected].
¹³ Department of Respiratory Medicine, Iwata City Hospital, Iwata, Japan. Electronic address: [email protected].
¹⁴ Department of Respiratory Medicine, Enshu Hospital, Hamamatsu, Japan. Electronic address: [email protected].
¹⁵ Department of Respiratory Medicine, Seirei Hamamatsu General Hospital, Hamamatsu, Japan. Electronic address: [email protected].
¹⁶ Department of Respiratory Medicine, Seirei Mikatahara General Hospital, Hamamatsu, Japan. Electronic address: [email protected].
¹⁷ Department of Respiratory Medicine, Fujieda Municipal General Hospital, Fujieda, Japan. Electronic address: [email protected].
¹⁸ Department of Respiratory Medicine, Hamamatsu Rosai Hospital, Hamamatsu, Japan. Electronic address: [email protected].
¹⁹ Department of Respiratory Medicine, Tenryu Hospital, Hamamatsu, Japan. Electronic address: [email protected].
²⁰ Department of Respiratory Medicine, Shizuoka General Hospital, Shizuoka, Japan. Electronic address: [email protected].
²¹ Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan; Center for Clinical Research, Hamamatsu University Hospital, Hamamatsu, Japan; Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].
²² Second Division, Department of Internal Medicine, Hamamatsu University School of Medicine, Hamamatsu, Japan. Electronic address: [email protected].

PMID: 39580034
DOI: 10.1016/j.rmed.2024.107881

Abstract

Background: Despite the development of biologics for severe asthma, individuals with uncontrolled status persist, posing a significant social problem. This multicenter prospective study aimed to identify factors associated with the uncontrolled status of patients with severe asthma in the biologic era assessed using the Asthma Control Questionnaire (ACQ).

Methods: Subjects with severe asthma diagnosed by respiratory specialists were enrolled from 11 hospitals. Clinical data and questionnaires were collected. We compared controlled (ACQ-5 <1.5) with uncontrolled severe asthma (ACQ-5 ≥1.5) and assessed factors linked to uncontrolled severe asthma using logistic regression analysis.

Results: One hundred fifty-four patients were analyzed (median age, 66 years; 62.3 % female; 52.6 % administered biologics). Among them, 56 patients (36.4 %) had uncontrolled severe asthma (ACQ-5 ≥1.5). The uncontrolled group had more frequent exacerbations (≥2 times in the previous year) and elevated blood neutrophil counts compared with the controlled group. Factors associated with uncontrolled status were analyzed in the overall population, with patients stratified into two groups: those receiving biologics and those not receiving biologics. Multivariate analysis revealed that frequent exacerbations and elevated blood neutrophil counts were associated with uncontrolled status in the overall population and in patients without biologics, whereas elevated blood neutrophil counts were significantly associated with uncontrolled status in patients receiving biologics.

Conclusion: Elevated blood neutrophil counts and frequent exacerbations were independently associated with uncontrolled severe asthma. Specifically, elevated blood neutrophil counts were a significant factor related to uncontrolled status irrespective of biologics, suggesting their potential utility as a biomarker in the biologic era.

Keywords: Asthma Control Questionnaire (ACQ); Biologic era; Blood neutrophil counts; Severe asthma; Uncontrolled.