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Original Research: Asthma |

Dedicated Severe Asthma Services Improve Health-care Use and Quality of LifeBenefits of Dedicated Severe Asthma Services

David Gibeon, MBChB; Liam G. Heaney, MD; Chris E. Brightling, PhD, FCCP; Rob Niven, MD; Adel H. Mansur, PhD; Rekha Chaudhuri, MD; Christine E. Bucknall, MD; Andrew N. Menzies-Gow, PhD, on behalf of the British Thoracic Society Difficult Asthma Network
Author and Funding Information

From Royal Brompton Hospital (Drs Gibeon and Menzies-Gow), London, England; Airways Disease (Dr Gibeon), National Heart and Lung Institute, Imperial College, London, England; the Centre for Infection and Immunity (Dr Heaney), Queen’s University of Belfast, Belfast, Ireland; the University of Leicester (Dr Brightling), Leicester, England; the University of Manchester (Dr Niven), Manchester, England; the University Hospital of South Manchester (Dr Niven), South Manchester, England; Birmingham Heartlands Hospital (Dr Mansur), University of Birmingham, Birmingham, England; Gartnavel General Hospital (Dr Chaudhuri), University of Glasgow, Glasgow, Scotland; and Glasgow Royal Infirmary (Dr Bucknall), Glasgow, Scotland.

CORRESPONDENCE TO: Andrew N. Menzies-Gow, PhD, Royal Brompton Hospital, Fulham Rd, London, SW3 6HP, England; e-mail: A.Menzies-Gow@rbht.nhs.uk


FOR EDITORIAL COMMENT SEE PAGE 843

FUNDING/SUPPORT: The authors have reported to CHEST that no funding was received for this study.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(4):870-876. doi:10.1378/chest.14-3056
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BACKGROUND:  Systematic assessment of severe asthma can be used to confirm the diagnosis, identify comorbidities, and address adherence to therapy. However, the prospective usefulness of this approach is yet to be established. The objective of this study was to determine whether the systematic assessment of severe asthma is associated with improved quality of life (QoL) and health-care use and, using prospective data collection, to compare relevant outcomes in patients referred with severe asthma to specialist centers across the United Kingdom.

METHODS:  Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics, and health-care use between initial assessment and a median follow-up of 286 days.

RESULTS:  The study population consisted of 346 patients with severe asthma. At follow-up, there were significant reductions in health-care use in terms of primary care or ED visits (66.4% vs 87.8%, P < .0001) and hospital admissions (38% vs 48%, P = .0004). Although no difference was noted in terms of those requiring maintenance oral corticosteroids, there was a reduction in steroid dose (10 mg [8-20 mg] vs 15 mg [10-20 mg], P = .003), and fewer subjects required short-burst steroids (77.4% vs 90.8%, P = .01). Significant improvements were seen in QoL and control using the Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire.

CONCLUSIONS:  To our knowledge, this is the first time that a prospective study has shown that a systematic assessment at a dedicated severe asthma center is associated with improved QoL and asthma control and a reduction in health-care use and oral steroid burden.


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