Severe asthma care trajectories: the French RAMSES cohort

Abstract

BackgroundThe French RAMSES study is an observational prospective multicentre real-life cohort including severe asthmatic subjects. The objective of the study was to compare the characteristics of patients, in terms of phenotype and asthma care trajectories, between those managed by tertiary referral centres (TRCs) or secondary care centres (SCCs).MethodsPatients were prospectively recruited and enrolled for a 5-year follow-up. Patients’ characteristics were analysed at inclusion and compared between TRCs and SCCs.Results52 centres (24 TRCs and 28 SCCs) included 2046 patients: 1502 (73.4%) were included by a TRC and 544 (26.6%) by a SCC. Patients were mainly women (62%), 53±15 years old, 67% with Asthma Control Test <20; at inclusion, 14% received oral corticosteroids (OCS) and 66% biologics. Compared with the SCC group, the TRC group had more frequent comorbidities and lower blood eosinophil counts (262versus340 mm−3; p=0.0036). OCS and biologics use did not differ between groups, but patients in the TRC group benefited more frequently from an educational programme (26%versus18%; p=0.0008) and received more frequently two or more sequential lines of biologics (33%versus24%; p=0.0105). In-depth investigations were more frequently performed in the TRC group (allergy tests: 74%versus62%; p<0.0001; exhaled nitric oxide fraction: 56%versus21%; p<0.0001; induced sputum: 6%versus3%; p=0.0390).ConclusionsPhenotypes and care trajectories differed in the RAMSES cohort between SCCs and TRCs, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardisation of severe asthma care.