Severe asthma care trajectories: the French RAMSES cohort

Abstract

Background/questionThe French RAMSES study is an observational prospective multicentre real-life cohort including severe asthmatics. The objective of the study was to compare the characteristics of patients, in terms of phenotype and asthma care trajectories, between those managed by tertiary referral centres (TRC) or secondary care centres (SCC).MethodsPatients were prospectively recruited and enrolled for a 5-year follow-up. Patients’ characteristics were analysed at inclusion and compared between TRC and SCC.ResultsFifty-two centres (24 TRC, 28 SCC) included 2046 patients: 1502 (73.4%) were included by a TRC and 544 (26.6%) by a SCC. Patients were mainly women (62%), 53±15 yr old, 67% with Asthma control test <20, 14% received at inclusion oral corticosteroids and 66% biologics. Compared with SCC, the TRC group had more frequent comorbidities, and lower blood eosinophil count (262/mm3versus340/mm3, p=0.0036). OCS and biologics use did not differ between groups but patients in the TRC group benefited more frequently from an educational program (26%versus18%, p=0.0008), and received more frequently ≥2 sequential lines of biologics (33%versus24%, p=0.0105). In-depth investigations were more frequently performed in the TRC group (allergy tests: 74%versus62%, p<0.0001; FeNO: 56%versus21%, p<0.0001; induced sputum: 6%versus3%, p=0.0390).Answer to the questionPhenotypes and care trajectories differed in the RAMSES cohort between SCC and TRC, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardisation of severe asthma care.