PATIENT-REPORTED TRIGGER NUMBER IS A STRONG PREDICTOR OF UNCONTROLLED DISEASE AMONG PATIENTS WITH SEVERE ASTHMA

Abstract

<h3>Introduction</h3> Severe asthma (SA) is associated with high morbidity. Numerous factors can trigger or exacerbate asthma symptoms and attacks through interactions with the airway epithelium. A better understanding of triggers among SA patients could help improve care. <h3>Methods</h3> CHRONICLE is an observational study of adults with SA receiving biologics, maintenance systemic corticosteroids (SCS), or uncontrolled on high-dosage inhaled corticosteroids and additional controllers. For patients enrolled February 2018–February 2021, this analysis examined associations between the number of patient-reported triggers (from a 17-category survey) and disease control (Asthma Control Test [ACT], work productivity, Saint George's Respiratory Questionnaire [SGRQ], HCP-reported exacerbations). Multivariate analyses further examined associations between disease control and trigger number or blood eosinophil counts [BEC]. <h3>Results</h3> Among 2847 enrolled patients, 1434 (51.3%) completed the triggers questionnaire. Median trigger number per patient was 8 (IQR: 5, 10). Most common triggers were weather/air changes, viral infections, seasonal allergies, perennial allergies, and exercise. Patients reporting more triggers experienced more poorly controlled disease, worse quality of life, reduced work productivity, and more exacerbations (<b>Figure</b>), which was confirmed by multivariate models. For all measures, trigger number was a stronger predictor than BEC. AUC-ROC for trigger number was higher than for BEC for predicting ≥1 exacerbations and ≥1 asthma hospitalizations (0.60 vs. 0.53 and 0.67 vs. 0.51, respectively). <h3>Conclusion</h3> Among US specialist-treated patients with SA, number of patient-reported triggers was a better predictor than BEC of disease morbidity across multiple measures. This highlights the importance of understanding patient-reported triggers in SA treatment.