番茄社区

SAN FRANCISCO -- Close to half of patients with severe or difficult to treat asthma participating in a large trial still had poorly controlled symptoms after a decade, researchers reported here.

The multicenter, observational TENOR II study evaluated the prevalence of persistent very poorly controlled asthma more than 10 years after their enrollment in which was designed to examine the causes of poor asthma control in this subset of patients.

Of the 327 patients with available asthma control data at both the 3-year TENOR I and 10-year TENOR II time points, nearly half (48%) had persistent very poorly controlled asthma, according to , of EpiMetrix in Los Altos, Calif., and colleagues.

Also, patients with very poor long-term asthma control had a higher incidence of gastroesophageal reflux disease (52.2% versus 41.2%) and they were also more than three times as likely to require hospitalization/emergency department visit for exacerbations requiring corticosteroids in the year prior to TENOR II assessment (29.7% versus 9.0%, respectively), they said in a presentation at the American Thoracic Society annual meeting.

In multivariable analyses, variables measured at TENOR I enrollment that significantly predicted persistent very poorly controlled asthma included black race versus white race, current or past smoking status, decreased post-bronchodilator FEV₁, and corticosteroid course for worsening asthma in the prior 3 months.

Mean pre- and post-bronchodilator percent predicted FEV₁ was lower in persistent very poorly controlled patients versus nonpersistent very poorly controlled patients. Total immunoglobulin E (IgE) geometric mean was higher in persistent very poorly controlled than nonpersistent very poorly controlled patients.

"Patients with persistent very poorly controlled asthma demonstrated higher disease burden, compromised lung function, and higher total and specific immunoglobulin E levels than patients with non-persistent very poorly controlled asthma," Haselkorn noted in a press statement.

The researchers also noted that data on medication use suggested that patients with persistent poorly controlled asthma are undertreated, either because appropriate medications are not prescribed or because compliance is poor.

, of the University of Kentucky College of Public Health in Lexington, who was not involved with the study, said noncompliance is among the most difficult challenges in the treatment of asthma.

"The goal is for all of our patients to be well controlled, but sometimes that just isn't attainable," he said.

He told 番茄社区 that the emergence of biologics and other new treatments could dramatically improve compliance for a select subgroup of patients.

"Some of the disease-modifying treatments we are beginning to see, where patients get injections every 8 weeks, or so may improve control," he said. "But these treatments aren't for everyone."

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