PRS47 Management of Severe Asthma in Portugal: Insights from a Delphi Panel

Abstract

To characterize the asthmatic patients in GINA 5 in the Portuguese National Health System, in terms of resource use by disease control and level of exacerbation, % OCS-dependent and % comorbidities. The study was conducted using a modified Delphi panel, composed of 6 reference physicians (pneumologists and immunoallergologists), that follow approximately 1870 asthmatic patients per year. GINA was used to define disease severity. Disease control was defined based on ACT score. A descriptive analysis was performed for the key variables. Based on panel results, severe asthma (GINA 5) represent 3% and 27% of the total adolescent (12-17 years old) and adult asthmatic patients follow by the physicians, respectively. Severe asthmatic patients are usually managed with a combined therapy of high doses of inhaled corticosteroids (ICS)/long-acting beta-2 agonists (LABA). Several options are usually added as a third drug in all patients for symptom relief. Despite the available therapies, 17% of patients are still systemic oral corticosteroids (OCS)-dependent. Regarding resource consumption: the share of controlled/uncontrolled patients attending each type of medical appointment is similar, however, uncontrolled patients need, on average, more appointments per year. The same was true when analyzing the consumption of exams. During exacerbations (moderate/severe), uncontrolled patients have additional consumption of resources, with most patients having to take antibiotics and OCS, while some even need hospitalization. Finally, when analyzing comorbidities, approximately 74% of severe asthma patients suffer from chronic rhinosinusitis, 34% from chronic rhinosinusitis with severe nasal polyposis, 19% from moderate-to-severe atopic dermatitis and 13% from food allergy. Severe asthma represents a great resource consumption. This fact is even more relevant in uncontrolled patients, namely due to moderate/severe exacerbations. Therapeutically there are still a relevant proportion of patients OCS-dependent, which is associated with many potential complications. Even with existing therapies, there remains an unmet need, especially in patients OCS-dependent.