Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma

Kim, Byung-Keun; Park, Soyoung; Ban, Ga Young; Kim, Mi Ae; Lee, Ji‐Hyang; An, Jin; Shim, Ji-Su; Lee, Youngsoo; Won, Ha-Kyeong; Lee, Hwa Young; Sohn, Kyung Hee; Kang, Sung-Yoon; Park, So Young; Lee, Hyun; Kim, Min-Hye; Kwon, Jae-Woo; Yoon, Sun‐Young; Lee, Jae-Hyun; Rhee, Chin Kook; Moon, Ji-Yong; Lee, Taehoon; Kim, So Ri; Park, Jong Suk; Kim, Sang‐Heon; Park, Heung-Woo; Jeong, Jae Won; Kim, Sang-Hoon; Koh, Young‐Il; Oh, Yeon‐Mok; Jang, An‐Soo; Yoo, Kwang Ha; Cho, You Sook

doi:10.4168/aair.2020.12.6.910

Cited by 23 publications

(18 citation statements)

References 77 publications

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“…Thus, multidisciplinary approaches are warranted to help these patients, including emotional, psychological and social support. There is a general consensus among specialist physicians that multidisciplinary care should be provided in clinics for severe asthma [ 3 , 23 – 26 ], but it is still unclear how this goal is being achieved, particularly how to provide a programme for physical and psychosocial support to the patients. Patient groups for severe asthma, where patients could meet and share experiences, may be helpful in supporting their psychosocial well-being.…”

Section: Discussionmentioning

confidence: 99%

Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma

et al. 2020

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BackgroundExacerbation is a defining feature of severe asthma, and oral corticosteroids (OCSs) are frequently prescribed to manage exacerbations. This qualitative study was conducted to examine the experience of patients with severe asthma, with a focus on asthma exacerbation and OCS treatment.MethodsAdults with severe asthma were recruited from three tertiary hospitals in South Korea. Data were collected through in-depth qualitative interviews. Verbatim transcripts were analysed using Colaizzi's phenomenological method to uncover the meaning of the participants’ experience. Recruitment of participants continued until thematic saturation.ResultsFourteen patients with severe asthma were recruited. Four theme clusters emerged: 1) experience of asthma exacerbation, 2) impact on life, 3) OCS treatments, and 4) disease perception. The patients experienced severe physical and psychosocial distress from asthma exacerbations, felt helpless due to failed efforts to prevent exacerbation, and were living a restricted life due to fear of exacerbation. They feared OCS side effects but had no other choice but to rely on OCS because other interventions were ineffective. Most had poor knowledge and understanding of severe asthma and the longterm health consequences.ConclusionAsthma exacerbation affects wide aspects of life in patients with severe asthma. Several components may underlie OCS reliance, including experience of distress during exacerbation, fear of future exacerbation, and lack of proper knowledge about long-term health consequences of severe asthma and OCS treatments. Multi-disciplinary approach is warranted to support the patients and to provide systematic education about long-term health implications of severe asthma.

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Section: Discussionmentioning

confidence: 99%

Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma

et al. 2020

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“…Severe asthma comprises approximately 4-10% of patients with asthma, [1][2][3][4] and 20-60% of patients with severe asthma need regular use of a systemic corticosteroid (CS) due to uncontrolled asthmarelated symptoms or frequent exacerbations. [5][6][7] Patients with CS-dependent asthma show an increased use of healthcare resources and higher mortality than other patients with asthma.…”

Section: Introductionmentioning

confidence: 99%

Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Choi

Lee

Ryu

et al. 2020

Ther Adv Respir Dis

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Background: Long-term corticosteroid (CS) use is associated with increased mortality in patients with asthma, and comorbid bronchiectasis is also associated with frequent asthma exacerbation and increased healthcare use. However, there is limited information on whether bronchiectasis further increases mortality in patients with CS-dependent asthma. This study examined the impact of bronchiectasis on mortality in patients with CS-dependent asthma. Methods: A retrospective cohort of patients with CS-dependent asthma ⩾18 years old was established using records from the Korean National Health Insurance Service database from 2005 to 2015. Patients with CS-dependent asthma with and without bronchiectasis were matched by age, sex, type of insurance, and Charlson comorbidity index. We evaluated the hazard ratio (HR) for all-cause mortality in patients with bronchiectasis compared with those without bronchiectasis. Results: The study cohort included 754 patients with CS-dependent asthma with bronchiectasis and 3016 patients with CS-dependent asthma without bronchiectasis. Patients with CS-dependent asthma with bronchiectasis had a higher all-cause mortality than those without bronchiectasis (8429/100,000 versus 6962/100,000 person-years, p < 0.001). The adjusted HR for mortality in patients with CS-dependent asthma with bronchiectasis relative to those without bronchiectasis was 1.33 (95% confidence interval, 1.18–1.50), and the association was primarily significant for respiratory diseases (subdistribution HR = 1.65, 95% confidence interval, 1.42–1.92). Conclusions: Bronchiectasis further increases all-cause mortality in patients with CS-dependent asthma, a trend that was especially associated with respiratory diseases including chronic obstructive pulmonary disease. Strategies to improve treatment outcomes in patients with CS-dependent asthma with bronchiectasis are urgently needed to improve long-term survival. The reviews of this paper are available via the supplemental material section.

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“…Our study results provide an important clinical implication that control of both lipid profiles and obesity may be more effective for prevention and treatment of asthma with the obesity phenotype. 20 …”

Section: Discussionmentioning

confidence: 99%

Additive Effect of Obesity and Dyslipidemia on Wheezing in Korean Adults: A Nationwide Representative Survey Study

Kim

Lee

Park

et al. 2021

Allergy Asthma Immunol Res

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Besides obesity, there are limited studies regarding the relationship between the individual components of metabolic syndrome and wheezing. It is largely unknown whether the co-existence of other metabolic syndrome components has additive effects on wheezing in the adult population. The association between the individual components of metabolic syndrome and current wheezing was evaluated in adults using data from the Korea National Health and Nutrition Examination Survey from 2008 to 2012. Subjects with metabolic syndrome more frequently had wheezing during the past 12 months (current wheezing) (adjusted odds ratio [aOR] = 1.56; 95% confidence interval [CI] = 1.37–1.77) and wheezing during exercise in the past 12 months (aOR = 1.59; 95% CI = 1.37–1.84). Of the individual metabolic syndrome components, central obesity (aOR = 1.48; 95% CI = 1.31–1.66) and low high-density lipoprotein (HDL) cholesterol (aOR = 1.18; 95% CI = 1.05–1.34) were significantly associated with current wheezing. There were no significant associations between the other components of metabolic syndrome (high triglyceride level, blood pressure, and fasting plasma glucose level) and the presence of current wheezing. In addition, the association was much higher when both central obesity and low HDL cholesterol were present together compared to when either of the conditions was present alone (aOR = 1.67; 95% CI = 1.44–1.94). There is a significant association between metabolic syndrome and current wheezing in Korean adults. Of the components of metabolic syndrome, low HDL cholesterol and central obesity are independently and additively associated with the increased rate of current wheezing.

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Evaluation and Management of Difficult-to-Treat and Severe Asthma: An Expert Opinion From the Korean Academy of Asthma, Allergy and Clinical Immunology, the Working Group on Severe Asthma

Cited by 23 publications

References 77 publications

Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma

Patients' experiences of asthma exacerbation and management: a qualitative study of severe asthma

Bronchiectasis and increased mortality in patients with corticosteroid-dependent severe asthma: a nationwide population study

Additive Effect of Obesity and Dyslipidemia on Wheezing in Korean Adults: A Nationwide Representative Survey Study

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