Protocol for the Wessex AsThma CoHort of difficult asthma (WATCH): a pragmatic real-life longitudinal study of difficult asthma in the clinic

Abstract

Background Asthma is now widely recognised to be a heterogeneous disease. The last two decades have seen the identification of a number of biological targets and development of various novel therapies. Despite this, asthma still represents a significant health and economic burden worldwide. Why some individuals should continue to suffer remains unclear. Methods The Wessex Asthma Cohort of Difficult Asthma (WATCH) is an ongoing ‘real-life’, prospective study of patients in the University Hospital Southampton Foundation Trust (UHSFT) Difficult Asthma service. Research data capture is aligned with the extensive clinical characterisation required of a commissioned National Health Service (NHS) Specialist Centre for Severe Asthma. Data acquisition includes detailed clinical, health and disease-related questionnaires, anthropometry, allergy and lung function testing, radiological imaging (in a small subset) and collection of biological samples (blood, urine and sputum). Prospective data are captured in parallel to clinical follow up appointments, with data entered into a bespoke database. Discussion The pragmatic ongoing nature of the WATCH study allows comprehensive assessment of the real world clinical spectrum seen in a Specialist Asthma Centre and allows a longitudinal perspective of deeply phenotyped patients. It is anticipated that the WATCH cohort would act as a vehicle for potential collaborative asthma studies and will build upon our understanding of mechanisms underlying difficult asthma. Electronic supplementary material The online version of this article (10.1186/s12890-019-0862-2) contains supplementary material, which is available to authorized users.

Clinical evaluation of type 2 disease status in a real‐world population of difficult to manage asthma using historic electronic healthcare records of blood eosinophil counts

“…WATCH is a prospective observational study of patients managed in a tertiary difficult asthma clinic at University Hospital Southampton with ‘high dose therapies’ and/or ‘continuous or frequent use of oral steroids’ according to the BTS (British Thoracic Society) Adult Asthma Management Guidelines 2016. Detailed study methodology has been published elsewhere 25 . The study had ethical approval (REC reference: 14/WM/1226), and all patients provided written informed consent.…”

“…Detailed study methodology has been published elsewhere. 25 The study had ethical approval (REC reference: 14/WM/1226), and all patients provided written informed consent.…”

“…27 Electronic clinical records were extracted where available to augment comprehensive data capture in a pragmatic fashion. 25 Patients with multiple blood test results (defined by 10 or more blood test results) over the preceding 10-years leading up to WATCH enrolment were identified. This cut-off was selected since the median number of eosinophil counts in the preceding decade for WATCH cohort enrolled subjects was 10.…”

Patient perceived barriers to exercise and their clinical associations in difficult asthma

“…All patients managed with British Thoracic Society Step "high dose therapies" and/or "continuous or frequent use of oral steroids" [1] in the Adult or Transitional Regional Asthma Clinic at UHSFT were invited to participate. Briefly, research data capture was aligned with the extensive clinical characterisation required of a commissioned National Health Service (NHS) Specialist Centre for Severe Asthma [25]. Data acquisition at enrolment included detailed clinical, health and disease-related questionnaires (Asthma Control Questionnaire (ACQ6), St George's Respiratory Questionnaire (SGRQ) and EQ-5D-5 L, Njimegen questionnaire for dysfunctional breathing, Sinonasal Outcome Test (SNOT22) for sinonasal symptom burden and Hospital Anxiety and Depression score (HADS) for anxiety and depression), anthropometry, allergy skin prick testing (SPT), lung function testing, radiological imaging (in a subset of those who were clinically indicated) and collection of biological samples (blood, and urine).…”

“…Brief longitudinal updates of data were obtained annually. A detailed outline of study protocol and methodology has previously been published [25]. The Exercise Therapy Burden Questionnaire (ETBQ) has been validated in French and Spanish for the assessment of barriers to physical activity in chronic illness and consists of 10 questions graded from 0 to 10; a higher score indicates higher perceived barriers to exercise [10,26,27] (see supplement for questionnaire).…”