Asthma Disease Burden Research Articles

Dupilumab Reduces Asthma Disease Burden and Recurrent SCS Use in Patients with CRSwNP and Coexisting Asthma.

Dupilumab significantly reduced the requirement for systemic corticosteroids (SCS) in patients with severe chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with CRSwNP and coexisting asthma typically have a higher disease burden and have more difficulty in managing disease. Here, we report an analysis of asthma outcomes and SCS use in patients with CRSwNP and coexisting asthma. This was a post hoc analysis of the randomized, placebo-controlled SINUS-24 and SINUS-52 studies (NCT02912468/NCT02898454) in patients with severe CRSwNP and coexisting asthma (patient self-reported) from the pooled intention-to-treat population randomized to dupilumab 300 mg every 2 weeks or placebo. On-treatment SCS use was estimated using Kaplan-Meier analysis. Forced expiratory volume in 1 s (FEV1), percent predicted FEV1, and the 6-item Asthma Control Questionnaire (ACQ-6) were assessed at baseline and Week 24 (pooled SINUS-24/52) in patients with/without history of asthma exacerbation or prior SCS use. Of 337 patients with coexisting asthma, 88 (26%) required on-treatment SCS use. The requirement for on-treatment SCS use for any reason was significantly lower with dupilumab (20/167 patients; 12%) vs placebo (68/170; 40%); hazard ratio (95% confidence interval) 0.248 (0.150-0.409); p<0.0001. The most frequent reasons for SCS use were nasal polyps (dupilumab 3% and placebo 27%) and asthma (2% and 9%, respectively). FEV1, percent predicted FEV1, and ACQ-6 were all significantly improved at Week 24 with dupilumab vs placebo irrespective of history of asthma exacerbation or prior SCS use (all p < 0.01). Dupilumab significantly reduced the requirement for SCS and improved asthma outcomes irrespective of history of asthma exacerbation or prior SCS use vs placebo in patients with CRSwNP and coexisting asthma, demonstrating concomitant reduction of SCS use and asthma disease burden in these patients.

Impacts of ambient air quality on acute asthma hospital admissions during the COVID-19 pandemic in Oxford City, UK: a time-series study

ObjectivesThe study aims to investigate the short-term associations between exposure to ambient air pollution (nitrogen dioxide (NO2), particulate matter pollution—particles with diameter<2.5 µm (PM2.5) and PM10) and incidence of asthma...

Global burden of asthma in young adults in 204 countries and territories, 1990–2019: Systematic analysis of the Global burden of disease study 2019

Asthma is a common chronic respiratory disease, with onset usually occurring during childhood or adolescence. The aim of this study was to estimate the dynamic changes in the burden of asthma disease among adolescents (aged 15–39 years). Between 1990 and 2019, our comprehensive analysis spanned 204 nations and territories to ascertain the global prevalence of asthma. This extensive evaluation meticulously quantified the disease's burden by examining a range of critical metrics—including mortality rates, prevalence figures, and disability-adjusted life-years (DALYs)—across diverse demographics. Our investigation systematically segmented the data by age, gender, and year, as well as by geographical regions and the Socio-demographic Index (SDI), offering an in-depth perspective on the multifaceted impact of asthma worldwide. From 1990 to 2019, there was a global increase in the incidence cases of asthma among young adults, with the number rising from 6487957.18 (95 %UI: 4578735.08–8736387.55) to 7604488.39 (95 % UI:5428024.98–10177808.25). The prevalence rate of asthma among young adults exhibited a decline from 580.09 per 1,00,000 (95 %UI:481.37–757.28) to 504.28 per 1,00,000 (95 %UI:400.64–633.26). It is also noteworthy that the incidence rates in the remaining SDI regions, although lower, also showed varying degrees of increase in 2015. The age-standardized disease burden rate for asthma among young adults has exhibited a decline over the course of the previous three decades. Nevertheless, regions characterized by lower SDI demonstrate elevated age-standardized mortality rates for asthma, thereby warranting focused attention and prioritized allocation of medical resources.

Real-world impact of dupilumab on asthma disease burden in Japan: The CROSSROAD study

BackgroundDupilumab, a human monoclonal anti-interleukin (IL)-4Ra antibody blocks the shared receptor component of IL-4 and IL-13, drivers of type 2 inflammation. Dupilumab is approved for severe/refractory asthma inadequately controlled by existing therapies, but knowledge of its effect on real-world disease burden is lacking. This study investigates real-world effects of dupilumab on asthma exacerbation risk and oral corticosteroid (OCS) use in Japanese individuals with asthma. MethodsThis retrospective, cohort study used a Japanese insurance claims database to identify patients who started dupilumab between 26 March 2019–31 May 2020. Patients were followed for ±365 days from dupilumab initiation. The study primarily assessed the annual incidence rate of severe asthma exacerbations occurring simultaneously with hospitalizations or OCS bursts. Secondary and exploratory endpoints assessed OCS dosage and duration, and healthcare resource utilization (HRU), respectively. ResultsAt dupilumab initiation (N = 215), mean age was 57.2 years, 41.9% of patients were aged ≥65 years, and 59.5% were female. Dupilumab significantly reduced the annual incidence of severe asthma exacerbations from 1.29 to 0.74 (95% confidence interval, 0.44–0.76) per patient per year. Mean OCS dosage decreased from 10.4 to 7.2 mg/day in chronic OCS users; median frequency of OCS bursts decreased from 3 to 0. Both unscheduled outpatient visits (35.8% vs 29.8%) and hospitalizations (21.9% vs 12.1%) decreased. Mean (standard deviation) duration of hospitalization also decreased from 6.7 (27.6) to 2.2 (8.1) days. ConclusionsJapanese patients with asthma who received dupilumab had reduced incidence rates of severe asthma exacerbations, OCS use, and HRU over 12 months.

Analysis of disease burden due to high body mass index in childhood asthma in China and the USA based on the Global Burden of Disease Study 2019.

Currently, there is a growing concern about the disease burden of child asthma particularly due to high body mass index (BMI). The prevalence and disease burden of asthma differ between developing and developed countries, with implications on disease intervention. Therefore, we provide a comparative analysis of childhood asthma between China and the United States of America (USA). Using the Global Burden of Disease (GBD) 2019 data, we estimated and compared the age-standardized prevalence, disability-adjusted life years (DALYs), years of life lost (YLLs), years of lost due to disability (YLDs), DALYs due to high BMI of asthma in children aged 1-14 years in China and the USA. Joinpoint regression analysis was applied to assess changes in temporal trends. DALYs due to high BMI and the ratio of DALYs to DALYs due to high BMI in children with asthma showed a significant upward trend in both countries and were higher in males than in females. Almost all epidemiological indicators of asthma showed a hump of curve from 2014 to 2019, and peaked in 2017. There was a decreasing trend of YLLs for asthma in children both countries, while China has a saliently greater decreasing trend. The disease burden caused by high BMI of childhood asthma was on the rise in children with asthma in both China and the USA. High BMI needs to be taken more into account in the development of future policies for the prevention, control, and treatment of childhood asthma. However, the increasing trend of this disease burden in American children was significantly lower than that in Chinese children. We recommend learning from the American government to impose a high-calorie tax, increase physical exercise facilities, and provide better health care policies.

Number of patient-reported asthma triggers predicts uncontrolled disease among specialist-treated patients with severe asthma

BackgroundPatients with severe asthma (SA) experience a high disease burden, often precipitated by exposure to disease triggers. ObjectiveTo evaluate the prevalence and effects of patient-reported triggers on asthma disease burden in a cohort of subspecialist-treated patients with SA in the United States. MethodsCHRONICLE is an observational study of adults with SA receiving biologics or maintenance systemic corticosteroids or whose disease is uncontrolled on high-dosage inhaled corticosteroids and additional controllers. Data were analyzed for patients enrolled between February 2018 and February 2021. This analysis evaluated patient-reported triggers from a 17-category survey and associations with multiple measures of disease burden. ResultsAmong 2793 enrolled patients, 1434 (51%) completed the trigger questionnaire. The median trigger number per patient was 8 (interquartile range, 5-10). The most frequent triggers were weather or air changes, viral infections, seasonal allergies, perennial allergies, and exercise. Patients reporting more triggers experienced more poorly controlled disease, worse quality of life, and reduced work productivity. The annualized rates of exacerbations and asthma hospitalizations increased by 7% and 17%, respectively, for each additional trigger (both P < .001). For all measures, trigger number was a stronger predictor of disease burden than blood eosinophil count. ConclusionAmong US specialist-treated patients with SA, asthma trigger number was positively and significantly associated with greater uncontrolled disease burden across multiple measures, which highlights the importance of understanding patient-reported triggers in SA. Trial RegistrationClinicalTrials.gov Identifier: NCT03373045.

Assessing the national burden of allergic asthma by web-search data, pollen counts, and drug prescriptions in Germany and Sweden

BackgroundAsthma and its main phenotype allergic asthma are prevalent, chronic, and complex diseases affecting 4% of the population. One main trigger for allergic asthma exacerbations is pollen. Online health information search behavior by people is increasing, and analysis of web-search data can provide valuable insight into disease burden and risk factors of a population. ObjectivesWe sought to perform a web-search data analysis and correlation to climate factors and pollen in 2 European countries. MethodsWe analyzed the national web-search volume for allergic asthma-related keywords in Germany and Sweden from 2018 to 2021 and correlated it to local pollen counts, climatic factors, and drug prescription rates. ResultsPer capita, more searches were conducted in Sweden than in Germany. A complex geographic stratification within the countries was observed. Search results were seasonal with a peak in spring and correlated with pollen counts in both countries. However, anti-asthmatic drug prescription rates in Sweden, as well as temperature and precipitation in both countries, did not correlate with search volume. ConclusionOur analysis offers population-level insights about this complex disease by reporting its needs and establishing the correlation to pollen counts, which enables a targeted approach in the public health management of allergic asthma. Local pollen counts, as opposed to temperature or precipitation, might be good predictors of allergic asthma disease burden.

Mechanistic Links Between Obesity and Airway Pathobiology Inform Therapies for Obesity-Related Asthma.

Obesity-related asthma is associated with a high disease burden and a poor response to existent asthma therapies, suggesting that it is a distinct asthma phenotype. The proposed mechanisms that contribute to obesity-related asthma include the effects of the mechanical load of obesity, adipokine perturbations, and immune dysregulation. Each of these influences airway smooth muscle function. Mechanical fat load alters airway smooth muscle stretch affecting airway wall geometry, airway smooth muscle contractility, and agonist delivery; weight loss strategies, including medically induced weight loss, counter these effects. Among the metabolic disturbances, insulin resistance and free fatty acid receptor activation influence distinct signaling pathways in the airway smooth muscle downstream of both the M2 muscarinic receptor and the β2 adrenergic receptor, such as phospholipase C and the extracellular signal-regulated kinase signaling cascade. Medications that decrease insulin resistance and dyslipidemia are associated with a lower asthma disease burden. Leptin resistance is best understood to modulate muscarinic receptors via the neural pathways but there are no specific therapies for leptin resistance. From the immune perspective, monocytes and T helper cells are involved in systemic pro-inflammatory profiles driven by obesity, notably associated with elevated levels of interleukin-6. Clinical trials on tocilizumab, an anti-interleukin antibody, are ongoing for obesity-related asthma. This armamentarium of therapies is distinct from standard asthma medications, and once investigated for its efficacy and safety among children, will serve as a novel therapeutic intervention for pediatric obesity-related asthma. Irrespective of the directionality of the association between asthma and obesity, airway-specific mechanistic studies are needed to identify additional novel therapeutic targets for obesity-related asthma.

Prevalence and Disability-Adjusted Life Year Rates of Asthma in China: Findings from the GBD Study 2019 of the G20.

The credible materials about the burden of asthma in China when compared to other countries in the group of twenty (G20) remain unavailable. Following the popular analysis strategy used in the Global Burden of Disease Study, the age-, sex-, country-specific prevalence, and disability-adjusted life years (DALYs) of asthma in China were analyzed. Meanwhile, the comparison in trends between China and other countries in the G20 was also evaluated. In 2019, asthma was the 8th leading cause of the DALYs' burden of 369 diseases in China. From 1990 to 2019, the age-standardized prevalence and DALY rates of asthma in China decreased by 14% and 51%, respectively; further, the decline rate of DALYs was much higher than the global average (-51%: -43%). It is worth noting that the overall population age-standardized DALYs rate of asthma in China was the lowest in the G20 during 2019 (102.81, 95% UI: (72.30,147.42)/100,000). Moreover, the age-standardized asthma prevalence rate peaks in both childhood (178.14, 95% UI: (90.50, 329.01)/100,000) and the elderly (541.80, 95% UI: (397.79, 679.92)/100,000). Moreover, throughout the study, subjects in the 5 to 9 years old interval were a constant focus of our attention. The disease burden of asthma has varied greatly by gender and age over the past 30 years. In contrast to the increasing burden in most other G20 countries, the age-standardized prevalence rate of asthma shows a significant decreasing trend in China, however, the age-standardized DALYs rate shows a fluctuating change, and has even shown a rebound trend in recent years.

Long-term efficacy of dupilumab in asthma with or without chronic rhinosinusitis and nasal polyps

BackgroundCoexisting chronic rhinosinusitis and nasal polyps (CRS-NPs) substantially increases the disease burden of asthma. Dupilumab, a fully human monoclonal antibody, has established efficacy and an acceptable safety profile in asthma and CRS with NP. ObjectiveTo evaluate long-term dupilumab efficacy in TRAVERSE (NCT02134028) patients with uncontrolled, moderate-to-severe (QUEST) or oral corticosteroid (OCS)-dependent (VENTURE) asthma with or without coexisting CRS-NP. MethodsIn TRAVERSE, 317 of 1530 (21%) QUEST and 61 of 187 (48%) VENTURE patients had self-reported CRS-NP; they received subcutaneous 300 mg dupilumab every 2 weeks up to 96 weeks. Patients were categorized by parent study treatment group (placebo/dupilumab, dupilumab/dupilumab). End points included annualized asthma exacerbation rates and mean change from parent study baseline in prebronchodilator forced expiratory volume in 1 second, Asthma Control Questionnaire 5 score, Asthma Quality of Life Questionnaire score, and OCS dose. ResultsPatients with coexisting CRS-NP had higher OCS dose and a history of more exacerbations. Concluding TRAVERSE, exacerbation rates decreased from 2.39 to 0.32 and 2.32 to 0.35 in dupilumab/dupilumab and 2.36 to 0.41 and 2.36 to 0.45 in placebo/dupilumab by week 96 from QUEST and VENTURE baselines, respectively. Non-CRS-NP results were similar. Improvements in forced expiratory volume in 1 second, Asthma Control Questionnaire 5 score, and Asthma Quality of Life Questionnaire score during parent studies were maintained in TRAVERSE; placebo/dupilumab patients achieved similar improvements to dupilumab/dupilumab by week 48. By week 96, 71% and 39% of OCS-dependent patients with CRS-NP and 83% and 47% without CRS-NP treated with dupilumab/dupilumab and placebo/dupilumab, respectively, stopped OCS. ConclusionLong-term dupilumab efficacy was maintained in patients with asthma with or without self-reported coexisting CRS-NP, including OCS-sparing effects observed in OCS-dependent severe asthma. Clinical Trial RegistrationClinicalTrials.gov Identifiers: NCT02528214, NCT02414854, and NCT02134028.

Influence of sex, cigarette smoking and airway inflammation on treatable traits in CBIOPRED severe asthma.

Influence of sex, cigarette smoking and airway inflammation on treatable traits in CBIOPRED severe asthma.

The prevalence and years lived with disability of asthma in children under 5 years old in Sichuan Southwest China, 1990-2019: A cross-sectional study.

ObjectivesTo analyze the prevalence and Years Lived with Disability of Asthma in children under 5 years old and the time trends in Sichuan Southwest China from 1990–2019.MethodsBased on the results of the Global Burden of Disease Study 2019 (GBD2019), we present the time trend, sex specific prevalence, Years Lived with Disability (YLDs) and deaths due to asthma under 5 years old in Sichuan and compared them with national indicators in the same period.ResultsThe number of children under 5 years old with asthma decreased overall from 1990 to 2007 and increased overall from 2008 to 2019. The time trend of prevalence rate was similar. In 2019, over 111 thousands children under 5 years old suffered from asthma, the prevalence rate was 2,584 per 100 thousand, YLDs was 4.5 thousands, and YLDs rate was 105 per 100 thousand in Sichuan. Compared with 1990, the number of patients decreased by 48.6%, the prevalence increased by 9.4%, the YLDs decreased by 48.9%, and the YLDs rate increased by 9.7% in 2019. The increase in the prevalence and YLDs rate of asthma children in Sichuan was higher than the national overall, but the number of asthma deaths and deaths rate in Sichuan and the whole nation all decreased.ConclusionsThe results in Sichuan Southwest China show the prevalence and YLDs of asthma children under 5 years old increased over the past 30 years, and were higher than the overall increase in China. Male children are the key population of increasing asthma disease burden and deserves more attention. More targeted prevention and control measures are still needed to reduce the incidence of asthma.

Determinants of asthma control and exacerbations in moderate to severe asthma

Determinants of asthma control and exacerbations in moderate to severe asthma

Dupilumab reduces asthma disease burden and recurrent SCS use in patients with CRSwNP and coexisting asthma

In the Phase 3 SINUS-24/-52 studies (NCT02912468/NCT02898454) dupilumab significantly reduced requirement for systemic corticosteroids (SCS) in patients with chronic rhinosinusitis with nasal polyps (CRSwNP). Patients with coexisting asthma typically have poorer outcomes and refractory disease. We report a post hoc analysis of SCS use and asthma outcomes in SINUS-24/52 patients with coexisting asthma.

The association between control level and self-reported treatment adherence across different treatment types in Japanese asthma patients.

Poor control of asthma symptoms is associated with a higher asthma disease burden, and asthma medication adherence is a known predictor for a better control status. This study sought to describe the current asthma control status, self-reported treatment adherence, and the association between them, as well as to describe how control level and better adherence impact the health outcomes of asthma patients. This study used cross-sectional data from the 2018 Japan National Health and Wellness Survey (NHWS). Asthma control status and adherence were assessed using the Asthma Control Test (ACT) and Morisky Medication Adherence Scale-8 (MMAS-8), respectively. Asthma treatment and patients' health outcomes, i.e. health-related quality of life (HRQoL) and work productivity, were self-reported. Asthma control and self-reported treatment adherence were analyzed descriptively, and the association was investigated by comparing mean ACT scores across adherence levels. Health outcomes were compared across control and adherence levels by multivariate analyses. A total of 816 patients had a physician diagnosis of asthma, with 67.0% reporting at least well controlled (ALWC). Of 505 asthma patients receiving prescription medication, half reported low adherence to medication use. Among asthma patients reporting high adherence, 35.6% were not well controlled (NWC). After adjusting for covariates, NWC asthma patients had significantly worse health outcomes than ALWC patients. One-third of asthma patients in Japan suffer from poorly controlled asthma. Results of the 2018 NHWS show that poor control status negatively affects patients' HRQoL and work productivity, suggesting an unmet need for better treatments to lessen the burden of asthma.

Models for estimating and projecting global, regional and national prevalence and disease burden of asthma: a systematic review.

BackgroundStatistical models are increasingly being used to estimate and project the prevalence and burden of asthma. Given substantial variations in these estimates, there is a need to critically assess the properties of these models and assess their transparency and reproducibility. We aimed to critically appraise the strengths, limitations and reproducibility of existing models for estimating and projecting the global, regional and national prevalence and burden of asthma.MethodsWe undertook a systematic review, which involved searching Medline, Embase, World Health Organization Library and Information Services (WHOLIS) and Web of Science from 1980 to 2017 for modelling studies. Two reviewers independently assessed the eligibility of studies for inclusion and then assessed their strengths, limitations and reproducibility using pre-defined quality criteria. Data were descriptively and narratively synthesised.ResultsWe identified 108 eligible studies, which employed a total of 51 models: 42 models were used to derive national level estimates, two models for regional estimates, four models for global and regional estimates and three models for global, regional and national estimates. Ten models were used to estimate the prevalence of asthma, 27 models estimated the burden of asthma – including, health care service utilisation, disability-adjusted life years, mortality and direct and indirect costs of asthma – and 14 models estimated both the prevalence and burden of asthma. Logistic and linear regression models were most widely used for national estimates. Different versions of the DisMod-MR- Bayesian meta-regression models and Cause Of Death Ensemble model (CODEm) were predominantly used for global, regional and national estimates. Most models suffered from a number of methodological limitations – in particular, poor reporting, insufficient quality and lack of reproducibility.ConclusionsWhilst global, regional and national estimates of asthma prevalence and burden continue to inform health policy and investment decisions on asthma, most models used to derive these estimates lack the required reproducibility. There is a need for better-constructed models for estimating and projecting the prevalence and disease burden of asthma and a related need for better reporting of models, and making data and code available to facilitate replication.

Defining pediatric asthma: phenotypes to endotypes and beyond.

Asthma is the most common chronic pediatric lung disease that has traditionally been defined as a syndrome of airway inflammation characterized by clinical symptoms of cough and wheeze. Highlighting the complex and heterogenous nature of asthma, this review summarizes recent advances in asthma classification that are based on pathobiology, and thereby directly addresses limitations of existent definitions of asthma. By reviewing and contrasting clinical and mechanistic features of adult and childhood asthma, the review summarizes key biomarkers that distinguish childhood asthma subtypes. While atopy and its severity are important features of childhood asthma, there is evidence to support the existence of a childhood asthma endotype distinct from the atopic endotype. Although biomarkers of non-atopic asthma are an area of future research, we summarize a clinical approach that includes existing measures of airway-specific and systemic measures of atopy, co-existing morbidities, and disease severity and control, in the definition of childhood asthma, to empower health care providers to better characterize asthma disease burden in children. Identification of biomarkers of non-atopic asthma and of the contribution of genetics and epigenetics to pediatric asthma burden remain a research need, which can potentially allow delivery of precision medicine to pediatric asthma.

ASSOCIATION BETWEEN ASTHMA SEVERITY, QUALITY OF LIFE, AND PRODUCTIVITY IN FRANCE, GERMANY, ITALY, SPAIN, AND THE UNITED KINGDOM

SESSION TITLE: Asthma: Mechanisms and Management SESSION TYPE: Original Investigations PRESENTED ON: October 18-21, 2020 PURPOSE: Although disease burden of asthma has been previously reported, limited up-to-date data exist on health-related quality of life (HRQoL) and productivity impairment among patients with asthma in Europe. This study evaluated the association between asthma, HRQoL, and productivity in five countries in Western Europe in 2018. METHODS: Nationally representative data from the population-based, cross-sectional, patient-reported National Health and Wellness Survey (NHWS) conducted among adults (age ≥18 years) in France, Germany, Italy, Spain, and the United Kingdom (UK) were used in this study. HRQoL was assessed using the 12-item Short-Form Health Survey [SF-12 v2; range of clinically important differences for Mental Component Summary (MCS) and Physical Component Summary (PCS): 3–5 points] and EuroQoL visual analogue scale (EQ-VAS; clinically important difference: 8 points); productivity was assessed using the Work Productivity and Activity Impairment Questionnaire: General Health (WPAI-GH). Two sets of analyses were conducted to compare HRQoL and WPAI-GH outcomes: a) between survey respondents with asthma (i.e. respondents who self-reported having asthma in the past 12 months, had a physician diagnosis of asthma, and reported receiving any prescription treatments for asthma) versus respondents without asthma (i.e. respondents who self-reported never having asthma), and b) between respondents with asthma who rated their asthma severity as mild (reference group) versus moderate or severe. RESULTS: The total survey sample was N=62,000; France/Germany/UK, n=15,000 each; Italy, n=10,000; and Spain, n=7000. Respondents with asthma (n=2934) reported significantly greater impairment versus respondents without asthma (n=54,748) on SF-12 (MCS; 43.92 vs 46.94); (PCS; 46.57 vs 50.68); EQ-VAS (66.0 vs 74.7); mean % total work productivity impairment (%TWPI; 27.62 vs 19.98); and mean % total activity impairment (%TAI; 36.57 vs 23.92). Among respondents with asthma reporting mild (n=1526), moderate (n=819), or severe disease (n=589), mean scores were: MCS, 44.83/43.27/42.46; PCS, 48.98/44.84/42.76; EQ-VAS, 70.5/62.6/59.2; %TWPI, 22.99/30.65/36.69; and %TAI, 30.18/41.38/46.45, respectively. Impairments on all outcomes were significantly greater among patients with moderate or severe asthma, versus patients with mild asthma. In all multivariable models, mean differences remained statistically significant (P<0.05) following adjustment for age, gender, Charlson Comorbidity Index, and country. CONCLUSIONS: Data from this 2018 NHWS study demonstrate the impairment in HRQoL and productivity among patients with asthma, specifically in those with moderate-to-severe asthma. CLINICAL IMPLICATIONS: Moderate-to-severe asthma is associated with significant impairments to HRQoL and productivity of patients. DISCLOSURES: Employee relationship with Kantar Please note: $1-$1000 Added 05/01/2020 by Kathy Annunziata, source=Web Response, value=Consulting fee No relevant relationships by Imène Gouia, source=Web Response No relevant relationships by Dena Jaffe, source=Web Response Employee relationship with Regeneron Pharmaceuticals Inc. Please note: >$100000 Added 05/27/2020 by Siddhesh Kamat, source=Web Response, value=Salary Employee relationship with Sanofi Please note: $20001 - $100000 Added 04/29/2020 by Asif Khan, source=Web Response, value=Salary Employee relationship with SANOFI Please note: >$100000 Added 05/27/2020 by Asif Khan, source=Web Response, value=Salary No relevant relationships by Nikoletta Sternbach, source=Web Response

Association of low-dosage systemic corticosteroid use with disease burden in asthma

There is an ongoing debate about the benefit–risk balance of systemic corticosteroids (SCS) in asthma treatment. We investigated the associations between SCS use and disease burden in a database cohort of asthmatics, categorized into SCS and non-SCS prescription at baseline and quartiles (Q) by cumulative SCS dosage. Of the 10,579 patients, the SCS cohort comprised 3103 patients (29.3%). Mean SCS dosages at baseline were 0.08, 0.29, 0.79, and 4.58 mg/day in Q1, Q2, Q3, and Q4, respectively. Similar SCS dosages were used within each quartile throughout the study period. No remarkable changes in asthma severity or control status were observed. All SCS cohorts had a higher risk of intermittent SCS exposure during the observation period. SCS use was associated with osteoporosis, diabetes, anxiety/neurosis, and depression. SCS-dependent treatment does not necessarily lead to the future improvement of asthma control; rather, it may negatively impact systemic health, even at mean dosages <5 mg/day.

PRS43 EPIDEMIOLOGICAL DISEASE BURDEN OF ASTHMA BASED ON ROUTINELY COLLECTED HEALTH INSURANCE CLAIMS DATA

The incidence and prevalence of asthma has shown a continuous increase in several countries. Hungarian data are less favourable compared to European Union average. The aim of our study was to determine the epidemiological disease burden of asthma. Data were derived from the financial database of the Hungarian National Health Insurance Fund Administration (NHIFA), for the year 2018. Data analysed included annual patient numbers, case numbers and prevalence of care utilisation per 100,000 population according to age groups and sex. The following health insurance treatment categories were included into our study: general practice care, home care, in- and outpatient care, medical imaging, laboratory diagnostics, drugs and medical aids. Patients with asthma were identified with the following code of the International Classification of Diseases 10th revision: J4590. The highest national patient numbers were in general practice care: 140,737 men and 188,275 women in total 329,012 patients, followed by drugs (132,783 men and 176,041 women, in total 308,824), and outpatient care (83,236 men, 124,848 women, in total 208,084). Based on patient numbers in general practice care, prevalence in 100,000 among men was 3,012.61 patients, among women 3,686.77 patients, in total 3,364.69 patients. As regards sex distribution in general practice care 42.78% of patients were men and 57.22% were women, while in the case of drugs 43.00% were men and 57.00% were women, in outpatient care 40.00% were men and 60.00% were women. Asthma was found to be 1.22 more prevalent in women. The reason for high patient numbers in general practice care and drugs is, that progression of the disease and relief of symptoms are primarily achieved with pharmacotherapy.