Abstract
BackgroundThe benefits of specialist assessment and management have yet to be evaluated within the biologic era of UK severe asthma treatment, and potential disparities have not been considered.MethodsIn an uncontrolled before-and-after study, we compared asthma symptoms (Asthma Control Questionnaire-6 (ACQ-6)), exacerbations, unscheduled secondary care use, lung function (forced expiratory volume in 1 s (FEV1)) and oral corticosteroid (OCS) dose after 1 year. We compared outcomes by sex, age (18–34, 35–49, 50–64 and ≥65 years), ethnicity (Caucasianversusnon-Caucasian) and hospital site after adjusting for demographics and variation in biologic therapy use.Results1140 patients were followed-up for 1370 person-years from 12 specialist centres. At annual review, ACQ-6 score was reduced by a median (interquartile range (IQR)) of 0.7 (0.0–1.5), exacerbations by 75% (33–100%) and unscheduled secondary care by 100% (67–100%). FEV1increased by a median (IQR) of 20 (−200–340) mL, while OCS dose decreased for 67% of patients. Clinically meaningful improvements occurred across almost all patients, including those not receiving biologic therapy. There was little evidence of differences across demographic groups, although those aged ≥65 years demonstrated larger reductions in exacerbations (69%versus52%; p<0.001) and unscheduled care use (77%versus50%; p<0.001) compared with patients aged 18–34 years. There were >2-fold differences between the best and worst performing centres across all study outcomes.ConclusionsSpecialist assessment and management is associated with substantially improved patient outcomes, which are broadly consistent across demographic groups and are not restricted to those receiving biologic therapy. Significant variation exists between hospitals, which requires further investigation.
Funder
Department for the Economy (DfE) Northern Ireland
Publisher
European Respiratory Society (ERS)
Subject
Pulmonary and Respiratory Medicine
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