Asthma Control Research Articles

Validation of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) for individuals with asthma

Purpose There are no disease-specific tools for assessing the functioning of patients with asthma. This study aims to evaluate the psychometric properties of the Brazilian version of the World Health Organization Disability Assessment Schedule (WHODAS 2.0) in individuals with asthma. Methods 101 individuals with asthma responded to the 36-item version of the WHODAS 2.0, Asthma Quality of Life Questionnaire (AQLQ), and Asthma Control Test (ACT). The following psychometric properties were tested: internal consistency, factor structure, and convergent and discriminative validity. Results Homogeneity was found between WHODAS 2.0 items and domains, except “Getting along” (Cronbach’s α = 0.57). When item “D4.5 Sexual activities” was deleted, the Cronbach’s increased to 0.70. Exploratory factor analysis identified four factors (explained variance 56%). There was a strong correlation between the WHODAS 2.0 and AQLQ (r=-0.72) and between the WHODAS 2.0 and ACT (r= −0.59). There was no evidence of the influence of obstruction level (FEV1) on functioning. Conclusion WHODAS 2.0 is a valid and reliable tool for assessing functioning in individuals with asthma. Exclusion of item D.4.5 Sexual activity increased the homogeneity between the items of the “Getting along” domain. When applied to asthmatics, the WHODAS total functioning score is preferable to the domain-specific scores.

The triple radiologic asthma phenotype is associated with worse disease control

BackgroundEfforts have been made to combine radiographical biomarkers such as bronchiectasis or bronchial wall thickness (BWT) to identify asthma sub-phenotypes and their clinical implications. ObjectiveTo assess whether a composite triple radiological phenotype measured by high resolution computed tomography comprising BWT, mucus plug score (MPS) and mediastinal lymph node (MLN) size might provide a better insight into sub-phenotypes in persistent asthma. MethodsOne hundred and twelve patients with moderate-to-severe asthma were included in this retrospective observational study. A binary method was used to classify patients according to median values for: pooled MLN≥3.6mm; BWT as pooled wall area ≥50% of the total airway area; and MPS≥1 where a mucus plug was considered positive if complete bronchial obstruction was imaged more than 2 cm from a pleural surface. ResultsPatients with the triple imaging phenotype exhibited significantly worse asthma control questionnaire scores exceeding minimal clinical important difference, a higher prevalence of concomitant chronic rhinosinusitis with nasal polyposis and a greater total IgE level. ConclusionWe have demonstrated an association between poorer symptom control and the triple radiological asthma phenotype.

Integrating hot topics and implementation of treatable traits in asthma.

People with asthma experience many different problems related to their illness. The number and type of problems differs between patients. This results in asthma being a complex and heterogeneous disorder which mandates a personalised approach to management. These features pose very significant challenges for the effective implementation of evidence-based management. Treatable Traits is a model of care that has been specifically designed to address these issues. Traits are identified in the pulmonary, extra-pulmonary (comorbidity) and risk factor/behavioural domains. Traits are clinically relevant, recognisable with validated trait identification markers, and treatable using evidence-based therapies. The clinician and patient agree on a personalised management plan that addresses the relevant traits, and trials show superiority of this approach with significant improvements in asthma control and quality of life. A number of tools have now been developed to assist the clinician in the implementation of this approach. The success of the treatable traits model of care is now being realised in other disease areas.

Asthma beliefs and overuse of short-acting beta-adrenergic receptor agonists among older adults

Objective Short-acting Beta-adrenergic Receptor Agonists (SABA) carry a risk of worse asthma outcomes when overused. Beliefs about asthma controller medications are associated with medication-taking behaviors in older adults, but the association of medication beliefs with SABA use has not been previously examined. We aimed to investigate the association of asthma and controller medication beliefs with SABA use among older patients with asthma. Methods We performed a cross-sectional analysis of data on adults ≥ 60 years old with moderate to severe asthma in New York City, NY (n = 234). SABA overuse was defined as the average of ≥1 inhalation per day and controller medication adherence as ≥80% of expected inhalations, measured electronically. Illness and medication beliefs were measured using the Brief-Illness Perception Questionnaire and Beliefs about Medications Questionnaire, respectively. The associations of medication-taking behaviors with beliefs were examined in multivariable logistic regression models. Results The mean age was 67.6 ± 6.5 years, 84% were female, 26% were Black and 53% were Hispanic. 35% of participants overused SABA and 21% had adequate controller medication adherence. Overuse of SABA was not significantly associated with controller medication beliefs (Necessity: odds ratio [OR] 1.04, 95% confidence interval [CI] [0.97–1.12], p = 0.28, Concerns: OR 0.95 [95% CI 0.88, 1.03], p = 0.23) or asthma beliefs (OR 1.06 [95% CI 0.99, 1.15], p = 0.11). SABA overuse was also not significantly associated with controller medication adherence (OR 2.20 [95% CI 0.88, 5.51], p = 0.09). Conclusions SABA overuse was common among older adults with asthma and was not significantly associated with asthma controller medication or illness beliefs.

Sexual Dysfunction in Women with Asthma and Associated Factors

Background: Asthma is a common chronic inflammatory airway disease. Female sexual dysfunction (FSD) is frequently seen in asthmatics but often unnoticed in clinical practice. This study evaluated the associations between asthma disease characteristics and (FSD). Methods: A total of 73 female asthma patients who visited the chest department outpatient clinic and age-matched 73 healthy controls were enrolled. All the participants completed the questionnaires: female sexual function index (FSFI), BECK depression, and BECK anxiety inventory, and underwent pulmonary function tests. Patients with asthma completed an asthma quality of life questionnaire (AQLQ) and asthma control test (ACT). FSD risk factors were analyzed using logistic regression analysis. Results: About 68.8% of asthmatics had female sexual dysfunction. BECK anxiety and FSFI scores with all six subsets were statistically significantly lower than healthy individuals in asthmatics (p < 0.001). CRP levels, BECK anxiety, and depression scores had inverse (r = -0.386 r = -0.343 r = -0.286), and FEV1% had a positive correlation with FSFI total scores. About 37.5% of asthma patients with FSD were current smokers, the most compromised domain of the FSFI scale was sexual arousal with a mean of 2.94 ± 0.56 and their FEV1% was lower, and CRP was higher than the asthma patients without FSD (p < 0.001, p < 0.021). Smoking, high levels of CRP and BECK anxiety scores, and low FEV1% were found to be risk factors for FSD in regression analysis. Conclusions: Female sexual dysfunction is frequently present in asthma patients. Smokers, patients who have anxiety, lower FEV1% predicted values, and higher CRP levels tend to be susceptible to sexual dysfunction, which implicates inflammation as an underlying mechanism.

Correlation of Vitamin D Levels with Severity of Asthma in Children Between 6 to 12 Years

Background: Millions of children worldwide suffer from chronic asthma, a serious respiratory disease that has a major influence on everyday living and health outcomes. There are significant public health concerns regarding the estimated 10-15% frequency of asthma in children in India. Vitamin D, which is recognized for its immunomodulatory qualities, according to recent studies reduces the severity. In this study, children aged 6 to 12 years old's vitamin D levels and the severity of their asthma were examined. Materials and Methods: At a tertiary care teaching hospital, 100 children between the ages of 6 and 12 who were presenting with acute exacerbations of bronchial asthma were the subjects of a prospective cohort study from August 2021 to August 2022. ELISA was used to evaluate serum 25-hydroxyvitamin D levels, and the GINA recommendations were used to determine the severity of asthma. Based on their levels of vitamin D, the kids were divided into three groups: sufficient (>30 ng/mL), insufficient (20–30 ng/mL), and deficient (<20 ng/mL). Children who were deficient in vitamin D were given supplements and monitored for three months. With SPSS 27, statistical analysis was carried out. Findings: The results of the study showed a strong correlation between increased asthma severity and inadequate asthma control and reduced vitamin D levels. Children with the most acute and uncontrollably asthmatic episodes were those with low vitamin D levels (<20 ng/mL). Significant improvements in asthma control, decreased activity limits, and decreased need for rescue medication were noted after three months of vitamin D administration. Conclusion: This study shows a clear link between children's asthma control issues and higher asthma severity when there is a vitamin D Deficiency. Supplementing with vitamin D significantly improved asthma outcomes, indicating a possible therapeutic role for this nutrient. Future studies with larger sample sizes and longer follow-up periods are recommended to validate these findings and further elucidate the underlying mechanisms.

Comparison of Asthma Control Test and GINA based assessment in Nepalese population: A cross-sectional study

Introduction: Asthma has a high age adjusted mortality in low- and middle-income countries like Nepal, which is preventable. Asthma control test (ACT) and GINA based assessment are the two most used tools to monitor effectiveness of the treatment. Utility these tools have not been evaluated in patients with asthma in Nepal. Objective: This study aims to compare the agreement between ACT and GINA assessment tools in Nepalese population. Methods: In a cross-sectional observational study, patients aged more than 18 years diagnosed as asthma at least three months prior were included. Active smokers and those with concomitant other respiratory disorder were excluded. ACT translated to native Nepali language was self-administered by the patient. GINA assessment of asthma control was recorded by the physician. Patients were classified as having well controlled, partially controlled and poorly controlled asthma by using both the tools. Spearman’s correlation coefficient was used to evaluate the agreement between the ACT and GINA based classification. Results: A total of 56 patients were included into the study. The mean age was 39 ± 12 years and the median duration of symptoms was 39.5 (IQR = 25.5-53.5) months. Using the GINA recommended asthma control tool, the number of patients with well controlled, partially controlled and poorly controlled asthma were 21 (38%), 24 (43%) and 11 (20%) respectively. Using the ACT scores, 35 (63%), 11 (20%) and 10 (18%) patients had well, partially, and poorly controlled asthma respectively. Both ACT and GINA score had a good agreement in classifying poorly controlled asthma. ACT and GINA scores had a weak positive yet statistically significant correlation (Spearman’s rho= 0.752, p= 0.019). Conclusions: ACT and GINA based assessment tools have good agreement to identify poorly controlled asthma in patients with asthma in Nepal.

Evaluation of maxillary sinus volume by cone beam computed tomography in asthma patients

ObjectiveThe study aims to evaluate maxillary sinus volume in asthmatic patients. MethodsPatients who applied to the faculty of dentistry between January 2014 and December 2023 were retrospectively screened. Cone beam computed tomography images of 312 maxillary sinuses (156 people) consisting of asthmatic patients and controls were included in the study. Radiographic images in the study were obtained with a Newtom 5 G (FP, Quantitative Radiology, Verona, Italy) cone beam computed tomography device. SimPlant Pro 16 program (Materialise NV, Leuven, Belgium) measured maxillary sinus volumes. SPSS 25.0 software (IBM SPSS, Inc.) was used to analyze statistical data. ResultsAs a result of the tests, the right and left maxillary sinus volumes of asthmatic patients were significantly smaller than the control group.No significant relationship was found between age and maxillary sinus in both the study and control groups. Gender distribution was equal between the groups.There was no significant difference between the groups in terms of age. No significant difference was found between the right and left maxillary sinus volumes. ConclusionConsidering that there is no other study in the literature measuring maxillary sinus volume in asthmatic patients, this study may guide future research.

A comparison of the impact of anti-IL5/5r therapies in allergic versus non-allergic patients with severe eosinophilic asthma in a real-life setting

Objective This study aimed to compare the clinical characteristics and treatment outcomes of allergic patients (AP) and non-allergic patients (NAP) with severe eosinophilic asthma (SEA) treated with anti-IL5/IL5R biologic agents (mepolizumab, benralizumab, or reslizumab) over one year. Sub-analyses assessed treatment response variations between AP and NAP based on the biological used and compared outcomes among AP with and without fungal allergy. Methods Observational retrospective analysis. Clinical characteristics, laboratory findings, pulmonary function tests, Asthma Control Test (ACT) scores, oral corticosteroid (OCS) usage, and exacerbation frequency were assessed at the initiation of biological treatment and after one year. Results Sixty-five patients with SEA were included, 41 AP and 24 NAP. 55.4% were treated with mepolizumab, 33.8% with benralizumab, and 10.8% with reslizumab. Before anti-IL5/5R treatment, AP had worse baseline outcomes but there were no differences in pulmonary function. Mean annual exacerbation rate and percentage of patients requiring OCS and dose of prednisone were higher in AP than NAP. AP had significantly higher total IgE values. After one year of treatment, more AP discontinued OCS than NAP (p = 0.025). Both experienced a significant reduction in exacerbation frequency (p = 0.001) and improved respiratory function. 70.7% of AP and 60% of NAP improved ACT ≥3 points. There was no significant difference between AP and NAP using mepolizumab (p = 0.145) or benralizumab (p = 0.174) in reducing OCS. Conclusions Anti-IL5/IL5R reduced the need for OCS and improved asthma control, regardless of allergic status. Fungal allergy led to lower ACT scores and higher exacerbations than other allergens; both groups improved with anti-IL5/ILR.

Breathing for Two: Asthma Management, Treatment, and Safety of Pharmacological Therapy during Pregnancy.

The primary objectives of asthma management during pregnancy are to achieve adequate symptom control, reduce the risk of acute exacerbations, and maintain normal pulmonary function, all of which contribute to ensuring the health and well-being of both the mother and the baby. The Global Initiative for Asthma (GINA) recommends that pregnant women with asthma continue using asthma medications throughout pregnancy, as the benefits of well-controlled asthma for both the mother and fetus outweigh the potential risks of medication side effects, poorly controlled asthma, and exacerbations. The classification of asthma medications by the US Food and Drug Administration (FDA) into categories A, B, C, D, and X is no longer applied. Instead, the potential benefits and risks of each medication during pregnancy and lactation are considered individually. The use of medications to achieve good asthma control and prevent exacerbations during pregnancy is justified, encompassing inhaled corticosteroids (ICS), some leukotriene receptor antagonists (LTRA), short-acting beta-2 agonists (SABA), long-acting beta-2 agonists (LABA), short-acting muscarinic antagonists (SAMA), long-acting muscarinic antagonists (LAMA), and, recently, biological therapies, even in the absence of definitive safety data during pregnancy.

Is Exclusive Small Airway Asthma a Possibility?

Although the small airway component of chronic asthma is becoming a more important topic, its impact in the daily assessment of pediatric asthma is limited. The intrinsic airway autonomic control in asthma suggests some potential mechanisms by which more distal obstruction may dominate in some situations. We suggest theoretical possibilities for small airway dominance and present clinical data supporting this possibility.

Clinical and Immunological Features of Bronchial Asthma Comorbid Chronic Urticaria: A Retrospective Study.

Asthma and chronic urticaria (CU) are two high prevalent diseases and often coexist. The underlying relationship and potential immunological mechanism between the two diseases are still unclear. The objective of this study was to investigate the clinical and immunological feature of asthma comorbid with CU. A retrospective study was conducted. Fifty patients with asthma comorbid CU, 50 patients with asthma, and 50 patients with CU alone were included. Age and sex of the patients enrolled were matched. Data of demographic characteristics, clinical manifestations including disease severity (frequency of symptoms, age of onset, disease duration, symptom score, complication with allergic rhinitis) as well as serum immunological index including total IgE (tIgE), allergen-specific IgE (sIgE), and food-specific IgG4 (FS-IgG4), were collected and analyzed. No significant differences in the frequency of symptoms, age of onset, and disease duration were found among the three groups. The score of asthma control test (ACT) in patients with asthma comorbid CU was significantly lower than that of asthma (p = 0.005); however, compared with patients with CU, the 7-day urticaria activity score (UAS7) of patients with asthma comorbid CU did not show obvious differences. Immunological index showed that the positive rates of tIgE, house dust mite (HDM)-sIgE, and FS-IgG4 were different among the three groups (p < 0.05). Patients with asthma comorbid CU had the highest rate of positive tIgE, moderate and severe positive sIgE to HDM. Egg-specific IgG4 (egg-sIgG4) had the highest positive rate in all groups. Patients of asthma comorbid CU obtained the highest rate of severe positive of egg-sIgG4. Our results demonstrated that patients with asthma comorbid CU have lower control level of asthma symptoms, higher tIgE and HDM-sIgE level, and highest rate of severe positive egg-sIgG4. These results indicate that comorbidity of CU in asthma obviously increases the severity of allergens.

Effect of Maternal Knowledge of Asthma Management on Quality of Life and Asthma Control among Children with Asthma: A Cross-Sectional Study.

This study aimed to evaluate the effect of mothers' knowledge about asthma management on quality of life and asthma control among children with asthma in Palestine. This cross-sectional study was carried out by mothers of children with asthma in Palestine in four major public hospitals. Mothers of a total of 220 were selected randomly via a computerized system. Data were collected using Pediatric Asthma Quality of Life (PAQLQ), an Asthma Control Test (ACT), and the mothers' Self-Practices and Knowledge (SPK) of asthma management questionnaire. Statistical analysis was performed using SPSS (V25). A total of 220 mothers of children with asthma were randomly selected and invited to participate but 182 agreed to participate, with a response rate of 83%. The mean age of participant children was 9.7 ± 2.72 years, and the mean age of mothers was 34.5 ± 9.6 years. The mean score of the QoL was 3.91(SD ± 1.61) out of 7. Most participant children had uncontrolled asthma with a total mean score of 14.13(SD ± 5.23) on the ACT. The mean score of mothers' SPK level was 2.12(SD ± 0.83) with a total mean score of 42.13 ± 3.68 out of 68, which indicated a moderate level of knowledge and there was a strong correlation between mothers' SPK and children's QoL. The investigation showed that mothers of children with asthma had moderate SPK, and the children had uncontrolled asthma with poor QoL. These findings suggest developing educational initiatives to enhance parents' asthma-related knowledge and skills to improve their children's asthma-related quality of life and asthma control.

Asthma control in severe asthma and occupational exposures to inhalable asthmagens

IntroductionWork-related asthma accounts for ≥25% of asthma in working-age populations, though the relationship between work exposures and symptoms is frequently missed, leading to poor health and employment outcomes. We hypothesised...

Immediate and One-Year Outcomes of an Asthma-Tailored Pulmonary Rehabilitation Programme in Overweight and Obese People with Difficult-to-Treat Asthma.

Management of difficult-to-treat asthma is particularly challenging in people with elevated body mass index (BMI). Our randomised controlled trial of pulmonary rehabilitation (PR) showed improved outcomes at 8weeks. Here we assess immediate and one-year effects of asthma-tailored PR in participants with difficult-to-treat asthma and BMI ≥25 kg/m2, and identify response predictors. A prospective observational study of PR, tailored to asthma, comparing outcomes at baseline (V1), immediately after 8 weeks of PR (V2), and at 1 year (V3). Baseline characteristics were compared in responders/non-responders defined by achievement of minimum clinically important difference (MCID) for asthma control questionnaire (ACQ6) (0.5) at 8weeks and 1 year. Of 92 participants, 56 attended V2 and 45 attended V3. Mean age was 60 (SD 13) years, 60% were female, and median (IQR) BMI was 33.8 (29.5-38.7) kg/m2. At V1, V2, and V3, respectively, there were significant differences in ACQ6 (mean (95% CI): 2.5 (2.1-2.9), 2.2 (1.8-2.5), and 2.3 (1.9-2.7), p<0.003), Borg breathlessness score post-6-minute walk test (median (IQR): 2 (0.5-3), 1 (0-2), and 1 (0.5-2), p<0.035), and annualised exacerbations requiring prednisolone (median (IQR): 3 (2-5), 0 (0-4.7), and 1.5 (0-4.2), p<0.003). A total of 27/56 (48%) had improvements >MCID for ACQ6 at V2 and 16 (33%) at V3. Participants with higher ACQ6 scores at baseline (suggesting poorer asthma control) were more likely to achieve MCID. Baseline BMI, within the range studied, was not predictive. Pulmonary rehabilitation induced improvements in asthma-related outcomes including perception of breathlessness, asthma control, and exacerbation frequency at 1 year. Those with poorer baseline asthma control were more likely to benefit.

Disease Burden, Treatment Patterns and Asthma Control in Adult Patients with Asthma in China: A Real-World Study.

To inform better asthma management in China, this study aimed to comprehensively investigate clinical characteristics, treatment patterns, asthma control status, exacerbations, and humanistic burden among adult patients seeking hospital-based asthma care by analyzing data from Adelphi Asthma Disease Specific Program conducted in China. All information was collected on survey date (August-December 2018) from medical records, physicians, or patients, without follow-up being conducted. Results are summarized descriptively for the overall population as well as subgroups defined by GINA 2018 treatment step. Of the included 765 patients, 46.0%, 40.4%, and 29.2% had undergone lung function, blood eosinophil count, and specific immunoglobulin E/radioallergosorbent testing, and 17.2%, 24.1%, and 58.7% were managed at GINA Steps 1-2, 3, and 4-5, respectively. Asthma was not well controlled in 57.3% of patients based on definitions adapted from the ERS/ATS and 10.7% of patients had experienced ≥1 severe exacerbation in the preceding year. According to patient self-reporting (n=603), the mean (SD) was 0.9 (0.1) for utility on EQ-5D-3L and was 7.8% (10.4%), 36.9% (20.0%), 40.8% (22.2%), and 37.9% (22.3%) for absenteeism, presenteeism, work productivity loss, and activity impairment, respectively, on WPAI. Both asthma control and humanistic burden worsened with progressive GINA treatment steps. In patients seeking hospital-based asthma care in China, lung function and biomarker tests were underutilized, impairment in productivity and quality of life was observed, and more than half did not achieve well-controlled asthma despite approximately 60% being managed at GINA treatment Steps 4-5. These findings highlight the urgent need for optimizing asthma management in China.

Concurrent validity, cut-offs and ability to change of patient-reported outcome measures for rhinitis and asthma in MASK-air®.

Patient-reported outcome measures (PROMs) are used to assess a patient's health status at a particular point in time. They are essential in the development of person-centred care. This paper reviews studies performed on PROMs for assessing AR and asthma control, in particular VAS scales that are included in the app MASK-air® (Mobile Airways Sentinel networK) for asthma and rhinitis. VASs were initially developed on paper and pencil and tested for their criterion validity, cut-offs and responsiveness. Then, a multicentric, multinational, double-blind, placebo-controlled, randomised control trial (DB-PC-RCT) using an electronic VAS form was carried out. Finally, with the development of MASK-air® in 2015, previously validated VAS questions were adapted to the digital format and further methodologic evaluations were performed. VAS for asthma, rhinitis, conjunctivitis, work and EQ-5D are included in the app. Additionally, two control-medication scores for allergic symptoms of asthma (e-DASTHMA) were validated for their criterion validity, cut-offs and responsiveness.

Asthma and Adolescence: Unique Opportunities for Fostering Asthma Self-Management and Asthma Control.

Asthma is a significant worldwide concern among adolescents. Adolescents experience key cognitive and psychosocial developmental changes that they must negotiate as they transition from children to adults. Several of these changes have implications for their ability to effectively manage their asthma. When health care professionals (HCPs) understand these pivotal changes and their role in asthma management, they are better able to work with adolescents and help them become effective asthma self-managers. Therefore, this article reviews the cognitive changes that render adolescents ready to care for their asthma, as well as the following psychosocial changes that may hinder or facilitate self-management: independence from caregivers, reliance on peers, identity development, the role of social media in adolescents' lives, and risk-taking behaviors. Each developmental task is discussed in terms of asthma self-management and offers suggestions for HCPs that may help them work more effectively with adolescents with asthma.

Symptoms Reported by Young Adults With Asthma During Wildfire Smoke Season

PurposeThe purpose of this article is to evaluate the relationship between exposure to poor air quality (AQ) and self-reported symptoms among young adults with asthma during wildfire smoke season. MethodsSixty seven young adults (aged 18–26 years) completed the Asthma Control Test and reported asthma symptoms at three time points (baseline, 4 weeks, and 8 weeks) during wildfire season as part of a clinical trial. Bivariate correlations between Asthma Control Test and AQ measures were examined followed by predictive linear regression. Multiple symptoms were compared between participants who experienced poor AQ and those who did not. ResultsAsthma control was inversely related to AQ with increased exposure to poor AQ tied to poor asthma control. A significantly greater proportion of participants reported critical respiratory symptoms when exposed to poor AQ than those who were not. DiscussionRespiratory symptoms are key indicators that young adults can monitor to optimize their asthma management during wildfire smoke season.

Prospective REALITI-A Study: 2-Year Real-World Benefits of Mepolizumab in Severe Asthma

BackgroundMepolizumab, a monoclonal antibody targeting interleukin-5, is of proven clinical benefit in severe asthma; prospective, long-term, real-world data in severe asthma are required. Research QuestionThis study aimed to assess the real-world benefit of 2 years’ mepolizumab treatment in severe asthma. Study Design and MethodsREALITI-A was a 2-year, international, prospective study enrolling adults with asthma, newly initiating mepolizumab 100 mg subcutaneously (physician decision). Outcomes in the 1-year pre-mepolizumab versus 2-year follow-up periods included rates of clinically significant asthma exacerbations (CSE; deterioration requiring systemic corticosteroids and/or emergency department [ED] visit/hospitalisation), exacerbations requiring ED visit/hospitalisation, exacerbations requiring hospitalisation, proportion of patients with no exacerbations, median daily maintenance oral corticosteroid (mOCS) dose, proportion of patients discontinuing mOCS completely, asthma control questionnaire (ACQ)-5 score, forced expiratory volume in 1s (FEV1) and adverse events (AEs). ResultsAfter 2 years’ follow-up, 73% of patients (n=599/822) had no record of mepolizumab discontinuation. During the 2-year follow-up versus pre-mepolizumab period (N=822), rates of CSEs, exacerbations requiring ED visit/hospitalisation, or hospitalisation only were reduced by 74%, 79% and 73%, respectively (odds ratio for no CSEs: 10.0; 95% confidence interval: 7.55, 13.25). Median (Q1, Q3) daily mOCS dose decreased from 10.0 (5.0, 14.7) mg at Week 0 (n=297) to 0.0 (0.0, 5.0) mg at Weeks 101–104 (n=168), and the proportion of patients discontinuing mOCS increased progressively to 43% at 1 year and 57% at 2 years. There was a 1.53-point reduction in ACQ-5 scores from baseline at 2 years. At Months 21–24, least square mean FEV1 improved by 142 mL from baseline. Ninety (11%) and 7 (<1%) patients experienced mepolizumab-related AEs and serious AEs during the follow-up period, respectively. InterpretationIn patients with severe asthma, real-world mepolizumab treatment for 2 years was well-tolerated, and was associated with sustained reductions in exacerbations and progressive reductions in mOCS use.