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Severe Asthma: Lungs

Hypothesis

  • Would systemic corticosteroid (SCS)-induced morbidity (e.g. diabetes, osteoporosis) be prevalent in severe asthma (SA) patients? If yes, how prevalent will it be?

  • Would a severe asthma morbidity (such as diabetes) be more prevalent than another (such as osteoporosis)? If yes, how so

  • Would the consequences of progression to daily maintenance oral corticosteroid (OCS) differ from the consequences of frequent rescue steroids exposure? If yes, how so?

Knowledge gap

  • Many past studies of respiratory disease include small numbers, were in mixed-disease populations, did not have control groups or relied on commercial healthcare reimbursement claims data/ patient self-reporting of symptoms or morbidity, and are hence not accurate.

  • There are only a few prevalence data in well-characterised severe asthma cohort that are available, and such data is insufficient to validate/ invalidate OPRI’s hypotheses.

Knowledge Generated

OCS has been proven in prior research as an effective treatment for acute asthma attacks and improving symptom control in patients with asthma. Prior research in other disease areas, for example rheumatology, in which OCS were once the commonplace standard of care research have shown adverse effects of systemic corticosteroids use, these studies were predominately in non-respiratory disease.

This study in asthma shows:

  • ​SCS-induced morbidity rates for severe asthma patients were significantly more prevalent (e.g. type II diabetes and osteoporosis) in comparison with mild/moderate.

  • morbidity rates for severe asthma patients were 7% and 4% for type II diabetes and osteoporosis respectively whereas

  • morbidity rates in mild/moderate asthma patients were 10% and 16% for type II diabetes and osteoporosis.

Findings

The results of earlier studies showing the effectiveness of steroids on improving symptom control in patients with asthma are found to be less meaningful/less significant than previously thought due to long-term adverse outcomes and could be potentially overthrown. Hence, with the new knowledge from the R&D study, the research community is now focusing on the effectiveness of alternative treatments in these severe asthma patients which can show similar or improved symptom control with limited long-term morbidity ‘’ Does treatment with biologics improve symptom control and reduce the risk of OCS-related adverse events’’ (phase 2).


Real-world application of new knowledge

  • Identification of an ‘’unacceptable threshold’’ for OCS/SCS exposure with clear evidence support – OPRI’s research has shown as little as four lifetime SCS courses can cause negative outcomes for patients with asthma (previously unknown). This finding is now being referenced in asthma guidelines globally.

  • Development of a new technological risk calculator which provides a personalised patient risk score/ safety threshold for severe asthma and OCS use has already been developed and new experiments for the tool are planned.

  • Supported the reimbursement of more biological treatments at lower costs due to the heightened healthcare resource utilisation from adverse effects of OCS/SCS in patients with untreated severe asthma

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