The impact of ethnicity on disease presentation and control in severe asthma

Abstract

<b>Background:</b> The role of ethnicity in severe asthma remains unclear although profound differences in outcomes and biologic phenotypes are evident when comparing countries globally. <b>Aims:</b> To assess the effects of ethnicity on disease control, exacerbations, biological phenotype and treatment in UK severe asthma. <b>Methods:</b> Multivariate comparison of demographics, asthma control, phenotypic presentation, medications and healthcare utilisation between White and Ethnic Minority Groups (EMGs) patients in UK primary (Optimum Patient Care Research Database [OPCRD]; n=13,936) and specialist (UK Severe Asthma Registry [UKSAR]; n=3,402) care. <b>Results:</b> EMG patients had higher levels of uncontrolled disease when measured using the asthma control questionnaire in the UKSAR (OR: 1.47; 95% CI: 1.12, 1.93) and the Royal College of Physicians 3 Questions in the OPCRD (OR: 1.82; 95% CI: 1.27, 2.60). Although exacerbation rates were similar, EMG patients were more likely to have attended ED (OR: 1.55; 95% CI: 1.26, 1.92) or been admitted to hospital (OR: 1.31; 95% CI: 1.07, 1.59) due to their asthma the year prior to specialist referral. Atopic disease was more common in EMG severe asthma in both UKSAR (OR: 1.32; 95% CI: 1.07, 1.63) and OPCRD (OR: 1.67; 95% CI: 1.26, 2.21). EMG patients were less likely to be using maintenance oral corticosteroids at specialist referral (OR: 0.75; [95% CI: 0.61, 0.92]) and were less commonly adherent with their maintenance medications in both UKSAR (OR: 0.65; 95% CI: 0.48, 0.87) and OPCRD (OR: 0.73; 95% CI: 0.60, 0.88). <b>Conclusions:</b> EMG patients had worse asthma control and increased emergency healthcare utilisation, with higher rates of atopy and distinct medication usage patterns.