Sociodemographic, Clinical and Pharmacological Characterization of Patients with Severe Asthma in Colombia: Experience of a Specialized Care Center
Article Sidebar
Main Article Content
Abstract
Introduction: The management of severe asthma is a worldwide challenge, due to its impact on quality of life and the risk of serious outcomes such as hospitalisations and death. This study aims to characterise patients in a centre specialising in managing severe asthma in Colombia.
Methods: Observational, retrospective study in patients seen between 2019 and 2022. Univariate analysis was performed with measures of central tendency and dispersion for quantitative variables; absolute and relative frequencies for qualitative variables; and bivariate analysis with chi-square and t-student tests taking as dependent variable the asthma control status.
Results: 377 patients were analysed, 78.5% female, mean age 57 years; 79.0% with 1-5 crises in the year before programme entry, and 19.6% with at least one-lifetime admission to the intensive care unit for crises. The most frequent therapy was biologic-inhaled corticosteroid/long-acting β2-agonist-long-acting muscarinic antagonist-leukotriene receptor antagonists (14.3%). Inadequate treatment was observed in 9.6%, with short-acting β2-agonist alone on an as-needed basis, LTRA monotherapy or a combination of LAMA/LTRA. Asthma control status at admission showed statistical association with being on biological therapy.
Conclusions: The population was characterised and the importance of adequate management of patients with severe asthma by specialised centres seeking the best possible therapy, at the lowest cost and with the greatest impact on disease control is highlighted.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2022. [Internet]. [Consultado 21 jun 2023]. Disponible en: https://ginasthma.org/wp-content/uploads/2023/05/GINA-Main-Report-2022-WMSA.pdf
Dennis RJ, Caraballo L, García E et al. Prevalence of asthma and other allergic conditions in Colombia 2009-2010: a cross-sectional study. BMC Pulm Med 2012;12:17.
Nwaru BI, Ekström M, Hasvold P, Wiklund F, Telg G, Janson C. Overuse of short-acting β2-agonists in asthma is associated with increased risk of exacerbation and mortality: A nationwide cohort study of the global SABINA programme. Eur Respir J 2020. Doi: 10.1183/13993003.01872-2019.
Ernst P, Spitzer WO, Suissa S et al. Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. JAMA 1992;268(24):3462-4.
Pandya D, Puttanna A, Balagopal V. Systemic effects of inhaled corticosteroids: an overview. Open Respir Med J 2014;8:59-65. Doi: 10.2174/1874306401408010059.
Hashimoto S, Bel EH. Current treatment of severe asthma. Clin Exp Allergy J Br Soc Allergy Clin Immunol 2012;42(5):693-705. Doi: 10.1111/j.1365-2222.2011.03936.x.
Inoue H, Nagase T, Morita S, Yoshida A, Jinnai T, Ichinose M. Prevalence and characteristics of asthma-COPD overlap syndrome identified by a stepwise approach. Int J Chron Obstruct Pulmon Dis 2017;12:1803-10. Doi: 10.2147/COPD.S133859.
Colombia. Ministerio de Salud, República de Colombia. Resolución 008430 de 1993, pp. 1-12. [Internet]. [Consultado 21 jun 2023]. Disponible en: https://minsalud.gov.co/sites/rid/Lists/BibliotecaDigital/RIDE/DE/DIJ/RESOLUCION-8430-DE-1993.pdf
Basagaña M, Martínez-Rivera C, Padró C et al. Clinical characteristics of complete responders versus non-complete responders to omalizumab, benralizumab and mepolizumab in patients with severe asthma: a long-term retrospective analysis. Ann Med 2024;56(1):2317356. Doi: 10.1080/07853890.2024.2317356.
Majellano EC, Yorke J, Clark VL et al. The illness burden of severe asthma contrasted to people with mild-to-moderate asthma: a qualitative study. ERJ Open Res 2024;10(3):00864-2023. Doi: 10.1183/23120541.00864-2023.
Jackson DJ, Busby J, Pfeffer PE et al. Characterisation of patients with severe asthma in the UK Severe Asthma Registry in the biologic era. Thorax 2021;76(3):220-7. Doi: 10.1136/thoraxjnl-2020-215168.
Nadif R. Asthma in the 21st Century: New Research Advances. Academic Press; 2022, pp. 264.
Wasti B, Chen Z, He Y, Duan WT, Liu SK, Xiang XD. Role of Sex Hormones at Different Physiobiological Conditions and Therapeutic Potential in MBD2 Mediated Severe Asthma. Oxid Med Cell Longev 2021;2021(1):7097797. Doi: 10.1155/2021/7097797.
Jenkins CR, Boulet LP, Lavoie KL, Raherison-Semjen C, Singh D. Personalized Treatment of Asthma: The Importance of Sex and Gender Differences. J Allergy Clin Immunol Pract 2022;10(4):963-971.e3. Doi: 10.1016/j.jaip.2022.02.002.
Miyasaka T, Dobashi-Okuyama K, Kawakami K, Masuda-Suzuki C, Takayanagi M, Ohno I. Sex Plays a Multifaceted Role in Asthma Pathogenesis. Biomolecules 2022;12(5):650. Doi: 10.3390/biom12050650.
Zein JG, Denson JL, Wechsler ME. Asthma over the Adult Life Course: Gender and Hormonal Influences. Clin Chest Med 2019;40(1):149-61. Doi: 10.1016/j.ccm.2018.10.009.
Honkamäki J, Hisinger-Mölkänen H, Ilmarinen P et al. Age- and gender-specific incidence of new asthma diagnosis from childhood to late adulthood. Respir Med 2019;154:56-62. Doi: 10.1016/j.rmed.2019.06.003.
Patadia MO, Murrill LL, Corey J. Asthma: symptoms and presentation. Otolaryngol Clin North Am 2014;47(1):23-32. Doi: 10.1016/j.otc.2013.10.001.
Alvarez-Gutiérrez FJ, Blanco-Aparicio M, Casas-Maldonado F et al. Documento de consenso de asma grave en adultos. Actualización 2022. Open Respir Arch 2022; 4(3): 100192. Doi: 10.1016/j.opresp.2022.100192.
Peters SP, Jones CA, Haselkorn T, Mink DR, Valacer DJ, Weiss ST. Real-world Evaluation of Asthma Control and Treatment (REACT): Findings from a national Web-based survey. J Allergy Clin Immunol 2007;119(6):1454-61. Doi: 10.1016/j.jaci.2007.03.022.
Calvo E, Trigueros JA, López A, Sánchez G. Control del asma en pacientes que acuden a consulta de atención primaria en España (estudio ACTIS). Aten Primaria 2017;49(10):586-92.
Alvear TG, Figueroa RL, Hurtado GJ, Moyano ML. Evaluación del grado de control del asma en un centro de atención primaria: Un estudio descriptivo. Rev Chil Enferm Respir 2016;32(2):68-76. Doi: 10.4067/S0717-73482016000200002.
Hancock KL, Bosnic-Anticevich S, Blakey JD et al. Characterisation of the Australian Adult Population Living with Asthma: Severe - Exacerbation Frequency, Long-Term OCS Use and Adverse Effects. Pragmatic Obs Res 2022;13:43-58. Doi: 10.2147/POR.S360044.
Zein JG, Erzurum SC. Asthma is Different in Women. Curr Allergy Asthma Rep 2015;15(6):28. Doi: 10.1007/s11882-015-0528-y.
Koebnick C, Fischer H, Daley MF et al. Interacting effects of obesity, race, ethnicity and sex on the incidence and control of adult-onset asthma. Allergy Asthma Clin Immunol 2016;12:50. Doi: 10.1186/s13223-016-0155-8.
Brumpton B, Langhammer A, Romundstad P, Chen Y, Mai XM. General and abdominal obesity and incident asthma in adults: the HUNT study. Eur Respir J 2013;41(2):323-9. Doi: 10.1183/09031936.00012112.
Ilmarinen P, Tuomisto LE, Niemelä O, Tommola M, Haanpää J, Kankaanranta H. Cluster Analysis on Longitudinal Data of Patients with Adult-Onset Asthma. J Allergy Clin Immunol Pract 2017;5(4):967-978.e3. Doi: 10.1016/j.jaip.2017.01.027.
Aguilar Cordero MJ. Obesidad y su relación con marcadores de inflamación y ácidos grasos de eritrocito en un grupo de adolescentes obesos. Nutr Hosp 2012;(1):161-4.
Leynaert B, Sunyer J, Garcia-Esteban R et al. Gender differences in prevalence, diagnosis and incidence of allergic and non-allergic asthma: a population-based cohort. Thorax 2012;67(7):625-31. Doi: 10.1136/thoraxjnl-2011-201249.
Alvis-Zakzuk NJ, Carrasquilla Sotomayor M, Zakzuk Sierra J et al. Direct Medical Costs Of Severe Asthma In Two Colombian Reference Centers. Value Health 2020;23:S361.
Barría P, Holguin F, Wenzel S. Asma Severa en Adultos: Enfoque Diagnóstico y Tratamiento. Rev Médica Clínica Las Condes 2015;26(3):267-75.
Global Initiative for Asthma. Global Strategy for Asthma Management and Prevention 2024 [Internet]. [Consultado 4 sept 2024]. Disponible en: https://ginasthma.org/wp-content/uploads/2024/05/GINA-2024-Strategy-Report-24_05_22_WMS.pdf
Jaun F, Tröster LM, Giezendanne S et al. Characteristics of Severe Asthma Patients and Predictors of Asthma Control in the Swiss Severe Asthma Registry. Respir Int Rev Thorac Dis 2023;102(10):863-78. Doi: 10.1159/000533474.
Nagase H, Oka H, Uchimura H et al. Changes in disease burden and treatment reality in patients with severe asthma. Respir Investig 2024;62(3):431-7. Doi: 10.1016/j.resinv.2024.02.007.
Sivan P, Noam N, Isaac S, Murad S, Fox B. Biologic treatments for severe asthma: 4 year experience of a single medical center. Isr Med Assoc J 2022;25(12):815-9.
Molina Castro D. Efectividad de un programa de atención integral del paciente con asma sobre la frecuencia de exacerbaciones en una institución de cuarto nivel de la ciudad de Bogotá (Colombia). 2019. [Internet]. [Consultado 21 jun 2023]; Disponible en: http://repository.urosario.edu.co/handle/10336/18952.