ATS 2021 will feature presentations of original research from accepted abstracts. Mini Symposia and Thematic Poster Sessions are abstract based sessions.
Please use the form below to browse scientific abstracts and case reports accepted for ATS 2021. Abstracts presented at the ATS 2021 will be published in the Online Abstract Issue of the American Journal of Respiratory and Critical Care Medicine, Volume 203, May 3, 2021.
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Factors Predictive of Exacerbations and Asthma Hospitalizations Among Patients with Specialist-Confirmed Severe Asthma in the United States
Session Title
TP10 - TP010 CLINICAL AND POPULATION-LEVEL STUDIES OF ASTHMA
Abstract
A1433 - Factors Predictive of Exacerbations and Asthma Hospitalizations Among Patients with Specialist-Confirmed Severe Asthma in the United States
Author Block: J. Trevor1, N. L. Lugogo2, W. C. Moore3, W. Soong4, R. A. Panettieri5, W. W. Carr6, W. Zhou7, P. Desai8, F. Trudo9, C. S. Ambrose10; 1Medicine, Univ of Alabama, Birmingham, AL, United States, 2Medicine, University of Michigan, Ann Arbor, MI, United States, 3Wake Forest Sch of Med, Winston-Salem, NC, United States, 4Alabama Allergy & Asthma Center, Birmingham, AL, United States, 5Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, United States, 6Allergy & Asthma Associates of Southern California, Mission Viejo, CA, United States, 7ClinChoice, Fort Washington, PA, United States, 8Amgen, Thousand Oaks, CA, United States, 9BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States, 10BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States.
Rationale: Patients with severe asthma (SA) are at increased risk for exacerbations and resulting hospitalizations. This study examined patient-level and site-level factors associated with exacerbations and hospitalizations in patients with SA in the United States (US). Methods: CHRONICLE is an observational study of specialist-treated US adults (aged ≥18 years) with SA. At enrollment, patients must be (1) receiving FDA-approved monoclonal antibody therapy for SA, (2) receiving systemic corticosteroids (SCS) or other systemic immunosuppressants for ≥50% of the prior 12 months, or (3) have persistently uncontrolled SA (per European Respiratory/American Thoracic Society guidelines) while treated with high-dosage inhaled corticosteroids and additional controllers. For those enrolled February 2018-February 2020, patient and site-level characteristics at enrollment were evaluated using multivariate Poisson regression models to identify predictors of exacerbation and asthma hospitalization incidence after enrollment. Factors were selected based on a single covariate association with P value <0.1 and a multi-covariate stepwise selection procedure requiring P value <0.05 to remain in the final models. Results: The analysis included 1884 enrolled patients who had complete data. Mean age was 54 years, and most patients were female (69%) and White (75%). Major factors increasing the exacerbation incidence rate were uncontrolled asthma (rate ratio [RR] 2.63) or partly controlled asthma (RR 2.40) based on specialist-answered Global Initiative for Asthma (GINA) control questions, residence in the South census region (RR 2.54), and each additional exacerbation in the 12 months preceding enrollment (RR 1.35) (Table). Chronic rhinosinusitis (RR 0.47) and a higher ratio of non-physicians to physicians at the specialist site (RR 0.77) were associated with decreased exacerbation incidence. Major factors increasing the asthma hospitalization incidence rate were residence in the South census region (RR 10.81), activity limitation reported by the specialist (RR 3.84), diagnosis of chronic obstructive pulmonary disease (RR 3.68), and each additional asthma hospitalization in the 12 months before enrollment (RR 1.90). Patients cared for only by an allergist/immunologist had a lower incidence of asthma hospitalization (RR 0.17) than those who received care from a pulmonologist as well as an allergist/immunologist. Conclusions: Consistent with previous findings, uncontrolled disease and prior asthma exacerbations/hospitalizations were predictive of future exacerbations/hospitalizations. Increased exacerbation/hospitalization risk in the South should be investigated further to explore potential causal factors. Lastly, the association between more nonphysician staff at the site and fewer exacerbations was perhaps due to increased patient education and support, leading to improved asthma outcomes.
Author Block: J. Trevor1, N. L. Lugogo2, W. C. Moore3, W. Soong4, R. A. Panettieri5, W. W. Carr6, W. Zhou7, P. Desai8, F. Trudo9, C. S. Ambrose10; 1Medicine, Univ of Alabama, Birmingham, AL, United States, 2Medicine, University of Michigan, Ann Arbor, MI, United States, 3Wake Forest Sch of Med, Winston-Salem, NC, United States, 4Alabama Allergy & Asthma Center, Birmingham, AL, United States, 5Institute for Translational Medicine and Science, Rutgers University, New Brunswick, NJ, United States, 6Allergy & Asthma Associates of Southern California, Mission Viejo, CA, United States, 7ClinChoice, Fort Washington, PA, United States, 8Amgen, Thousand Oaks, CA, United States, 9BioPharmaceuticals Medical, AstraZeneca, Wilmington, DE, United States, 10BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, MD, United States.
Rationale: Patients with severe asthma (SA) are at increased risk for exacerbations and resulting hospitalizations. This study examined patient-level and site-level factors associated with exacerbations and hospitalizations in patients with SA in the United States (US). Methods: CHRONICLE is an observational study of specialist-treated US adults (aged ≥18 years) with SA. At enrollment, patients must be (1) receiving FDA-approved monoclonal antibody therapy for SA, (2) receiving systemic corticosteroids (SCS) or other systemic immunosuppressants for ≥50% of the prior 12 months, or (3) have persistently uncontrolled SA (per European Respiratory/American Thoracic Society guidelines) while treated with high-dosage inhaled corticosteroids and additional controllers. For those enrolled February 2018-February 2020, patient and site-level characteristics at enrollment were evaluated using multivariate Poisson regression models to identify predictors of exacerbation and asthma hospitalization incidence after enrollment. Factors were selected based on a single covariate association with P value <0.1 and a multi-covariate stepwise selection procedure requiring P value <0.05 to remain in the final models. Results: The analysis included 1884 enrolled patients who had complete data. Mean age was 54 years, and most patients were female (69%) and White (75%). Major factors increasing the exacerbation incidence rate were uncontrolled asthma (rate ratio [RR] 2.63) or partly controlled asthma (RR 2.40) based on specialist-answered Global Initiative for Asthma (GINA) control questions, residence in the South census region (RR 2.54), and each additional exacerbation in the 12 months preceding enrollment (RR 1.35) (Table). Chronic rhinosinusitis (RR 0.47) and a higher ratio of non-physicians to physicians at the specialist site (RR 0.77) were associated with decreased exacerbation incidence. Major factors increasing the asthma hospitalization incidence rate were residence in the South census region (RR 10.81), activity limitation reported by the specialist (RR 3.84), diagnosis of chronic obstructive pulmonary disease (RR 3.68), and each additional asthma hospitalization in the 12 months before enrollment (RR 1.90). Patients cared for only by an allergist/immunologist had a lower incidence of asthma hospitalization (RR 0.17) than those who received care from a pulmonologist as well as an allergist/immunologist. Conclusions: Consistent with previous findings, uncontrolled disease and prior asthma exacerbations/hospitalizations were predictive of future exacerbations/hospitalizations. Increased exacerbation/hospitalization risk in the South should be investigated further to explore potential causal factors. Lastly, the association between more nonphysician staff at the site and fewer exacerbations was perhaps due to increased patient education and support, leading to improved asthma outcomes.
