Factors Associated with Frequent Exacerbations in the UK Severe Asthma Registry

Freda Yang; John Busby; Liam G Heaney; Andrew Menzies-Gow; Paul E Pfeffer; David J Jackson; Adel H Mansur; Salman Siddiqui; Christopher E Brightling; Robert Niven; Neil C Thomson; Rekha Chaudhuri; UK Severe Asthma Registry

doi:10.1016/j.jaip.2020.12.062

Factors Associated with Frequent Exacerbations in the UK Severe Asthma Registry

J Allergy Clin Immunol Pract. 2021 Jul;9(7):2691-2701.e1. doi: 10.1016/j.jaip.2020.12.062. Epub 2021 Jan 15.

Authors

Collaborators

UK Severe Asthma Registry:
Mitesh Patel, Robin Gore, Thomas Brown, Aashish Vyas, Deepak Subramanian

Affiliations

¹ Gartnavel General Hospital, Glasgow, UK; University of Glasgow, Glasgow, UK. Electronic address: Jieqiong.yang@nhs.net.
² Queen's University Belfast, Belfast, UK.
³ Royal Brompton Hospital, London, UK.
⁴ St. Bartholomew's Hospital, Barts Health NHS Trust, London, UK; Queen Mary University of London, London, UK.
⁵ Guy's and St. Thomas' NHS Trust, London, UK; King's College London, London, UK.
⁶ Birmingham Heartlands Hospital, Birmingham, UK; University of Birmingham, Birmingham, UK.
⁷ Institute for Lung Health, Leicester NIHR BRC, University of Leicester, Leicester, UK.
⁸ MAHSC, The University of Manchester and Manchester Foundation Trust, Manchester, UK.
⁹ University of Glasgow, Glasgow, UK.
¹⁰ Gartnavel General Hospital, Glasgow, UK; University of Glasgow, Glasgow, UK.

PMID: 33460858
DOI: 10.1016/j.jaip.2020.12.062

Abstract

Background: Frequent exacerbations are an important cause of morbidity in patients with severe asthma.

Objective: Our aim was to identify factors associated with frequent exacerbations in a large well-characterized severe asthma population and determine whether factors differed in patients treated with and without maintenance oral corticosteroids (OCS).

Methods: Adults with severe asthma from specialized asthma centers across the United Kingdom were recruited to the UK Severe Asthma Registry. Demography, comorbidities and physiological measurements were collected. We conducted univariable and multivariable logistic regression analyses to identify factors associated with frequent exacerbations, defined as 3 or more exacerbations treated with high-dose systemic corticosteroids in the past year.

Results: Of 1,592 patients with severe asthma from the UK Severe Asthma Registry, 1,137 (71%) were frequent exacerbators and 833 (52%) were on maintenance OCS. The frequent exacerbators were more likely to be ex-smokers, have gastroesophageal reflux disease, higher Asthma Control Questionnaire-6 (ACQ-6) score, and higher blood eosinophilia. Multivariable regression analyses showed ACQ-6 score greater than 1.5 (odds ratio [OR] 4.25; P < .001), past smoking history (OR 1.55; P = .024), and fractional exhaled nitric oxide greater than 50ppb (OR 1.54; P = .044) were independently associated with frequent exacerbations. Past smoking history correlated with frequent exacerbations only in patients on maintenance OCS (OR 2.25; P = .004), whereas ACQ-6 score greater than 1.5 was independently associated with frequent exacerbations in those treated with and without maintenance OCS (OR 2.74; P = .017 and OR 6.42; P < .001, respectively).

Conclusions: Several factors were associated with frequent exacerbations in a large UK severe asthma registry population. High ACQ-6 score had the strongest association with frequent exacerbations irrespective of maintenance OCS status.

Keywords: ACQ; Asthma control; Exacerbations; Frequent exacerbations; Severe asthma.

MeSH terms

Adrenal Cortex Hormones / therapeutic use
Adult
Anti-Asthmatic Agents* / therapeutic use
Asthma* / drug therapy
Asthma* / epidemiology
Eosinophilia*
Humans
Registries
United Kingdom / epidemiology

Substances

Adrenal Cortex Hormones
Anti-Asthmatic Agents