FASE-CPHG study: a panoramic snapshot of difficult-to-treat, severe asthma in French nonacademic hospitals

Laurent Portel; Eric Parrat; Cécilia Nocent-Ejnaini; Gilles Mangiapan; Anne Prud'homme; Jean-Philippe Oster; Corinne Aperre de Vecchi; Cyril Maurer; Chantal Raherison; Didier Debieuvre

doi:10.1183/23120541.00069-2019

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FIGURE 1
Study flow chart: pulmonologist participation and patient recruitment. CRF: case report form.

Tables

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Supplementary Materials

TABLE 1

Confirmation of severe asthma in the analysed population

	Confirmed severe asthma	Not confirmed severe asthma	Missing data	Total
Subjects	1377	78	10	1465
GINA step
Step 1	0	1 (1)		1 (0)
Step 2	0	0		0
Step 3	24 (2)	8 (10)		32 (2)
Step 4	565 (41)	41 (53)		606 (41)
Step 5	788 (57)	28 (36)		816 (56)
Unknown			10	10 (1)
Patient follow-up <6 months	0	73 (94)		73 (5)

Data are presented as n or n (%). GINA: Global Initiative for Asthma.

TABLE 2

Patient characteristics

Subjects n	1465
Female	921 (63)
Age years	54.4±16.1
18–39	281 (19)
40–59	586 (40)
≥60	598 (41)
BMI kg·m⁻²	27.6±6.2
<18	45 (3)
18–24.99	512 (35)
25–29.99	473 (32)
≥30	435 (30)
Physical activity level
No activity	440 (32)
Occasional	528 (38)
Regular	323(23)
Common or at competition level	99 (7)
Missing data	75
Educational level
Ongoing	8 (1)
No diploma	420 (32)
Certificate of general education (junior high school)	413 (31)
Baccalaureate (high school)	200 (15)
Post-baccalaureate diplomas (bachelor and graduate)	285 (21)
Missing data	139
Professional status
Active	596 (42)
Inactive	311 (22)
Retired	511 (36)
Missing data	47
Smoking status
Current smokers	170 (12)
Ex-smokers	424 (29)
Non-smokers	871 (60)
Smoking history pack·years⁻¹	17.9±14.8
History of atopy
Personal atopy	958 (65)
Familial atopy	566 (39)
Animal exposure
Domestic animals	610 (42)
Dogs	385 (63)
Cats	341 (56)
Others (rabbits, rodents, birds, …)	64 (11)
Nondomestic animals	115 (8)
Housing
Urban	697 (48)
Rural	391 (27)
Semi-rural	377 (26)
Residence proximity to a pollution source	148 (10)
Residence proximity to a trunk road	290 (20)

Data are presented as n, n (%) or mean±sd. BMI: body mass index.

TABLE 3

Asthma control

	Control according to GINA criteria				Total	p-value
	Well controlled	Partially controlled	Uncontrolled	Missing data	Total	p-value
Control assessed by the physician
Well controlled	50 (10.1)	229 (46.1)	217 (43.8)	11	507 (37.4)	<0.0001
Partially controlled	2 (0.3)	98 (17)	479 (82.7)	19	598 (44.1)
Uncontrolled	1 (0.4)	7 (2,9)	236 (96.7)	6	250 (18.5)
Missing data	0	0	5	7	12
Total	53 (4)	334 (25.2)	937 (70.8)	43	1367 (100)

Data are presented as n (%) or n, unless otherwise stated. GINA: Global Initiative for Asthma.

TABLE 4

Asthma history

Subjects	1465
Age at asthma onset years	26.9±20.4
≤12	496 (34)
13–39	544 (37)
≥40	417 (29)
Missing data	8
Asthma duration years	27.4±17.9
Pulmonology follow-up duration years	13.5±12.7
History of acute severe asthma	757 (52)
>2 exacerbations in the past year	949 (65)
Exacerbation history in the past year
Medical consultations	2.6±3.1
Hospitalisations for asthma	0.5±1.3
Visits to emergency room	0.6±1.7
Severe exacerbation	2.5±3.1
Absenteeism from work/school due to asthma in the past year days	35.3±68.1

Data are presented as n, mean±sd or n (%).

TABLE 5

Medical history and comorbidities

Subjects	1465
Medical history
Aspirin intolerance	160 (10.9)
Widal syndrome	101 (6.9)
Food allergy	153 (10.5)
Drug allergy	207 (14.1)
Atopic dermatitis	225 (15.4)
Allergic bronchopulmonary aspergillosis	40 (2.7)
Churg–Strauss syndrome	15 (1)
ENT disease	862 (58.9)
Chronic rhinitis	655 (44.7)
Chronic rhinosinusitis	358 (24.5)
Polyposis	265 (18.1)
Comorbidities (ENT disease excluded)
No comorbidity	387 (26.5)
1 comorbidity	435 (29.8)
2 comorbidities	290 (19.8)
≥3 comorbidities	350 (23.9)
Missing data	3
Gastro-oesophageal reflux disease	573 (39.1)
Arterial hypertension	372 (25.5)
Diabetes	149 (10.2)
Ischaemic cardiopathy	72 (5)
Sleep apnoea	161 (11)
Osteoporosis	156 (10.7)
Anxiety	579 (39.5)
Depression	208 (14.2)
Other mental disorder	32 (2.2)
Anxiety and depression determined with self-assessment questionnaires	1367
Anxiety level (HADS-A)	7.4±4.4
Presence of anxiety (score >7)	583 (43.3)
Absence of anxiety (score ≤7)	763 (56.7)
Missing data	21
Depression level (HADS-D)	5.1±3.8
Presence of depression (score >7)	320 (23.6)
Absence of depression (score ≤7)	1038 (76.4)
Missing data	9

Data are presented as n, n (%) or mean±sd. ENT: ear, nose and throat; HADS: Hospital Anxiety and Depression Scale; A: anxiety; D: depression.

TABLE 6

Allergy-related asthma assessment

Subjects	1465
Allergic sensitisation^#
No allergic sensitisation	353 (24.2)
At least one allergic sensitisation	823 (56.4)
No allergological exploration	282 (19.3)
Missing data	7
Positive allergic sensitisation tests
Dust mite	638 (77.5)
Pollens	469 (57)
Domestics animals	363 (44.1)
Moulds/Alternaria alternate	161 (19.6)
Cockroach	55 (6.77)
Others (including flour and dust)	68 (8.3)
Cutaneous test	1038 (71.2)
Positive	736 (71.2)
Negative	297 (28.8)
Missing data	5
Total serum IgE test	907 (62.2)
Total serum IgE UI·L⁻¹	546.1±1013.2
Specific serum IgE test	544 (37.3)
Positive	310 (57.6)
Negative	228 (42.4)
Missing data	6
Blood eosinophils count	1092 (74.9)
Blood eosinophils cells·mm⁻³	436.8±466.4
<300	509 (46.7)
300–499	255 (23.4)
≥500	327 (30.0)
Aspergillus serology	659 (45.2)
Positive	69 (10.5)
Negative	589 (89.5)
Missing data	1
Multiallergic serum testing	124 (9.3)
Positive	55 (44.7)
Negative	68 (55.3)
Missing data	1

Data are presented as n, n (%) or mean±sd. Ig: immunoglobulin. ^#: defined by positive cutaneous test or positive specific serum IgE test.

TABLE 7

Biology and lung function tests

Subjects	1465
α₁-antitrypsin test	157 (10.8)
<0.8 g·L⁻¹	6 (3.8)
0.8–0.99 g·L⁻¹	4 (2.6)
≥1 g·L⁻¹	145 (93.5)
Mean result g·L⁻¹	1.3±0.4
Pulmonary function tests	1321 (98.2)
Time since last spirometry months	2.1±8
Last spirometry assessed during the visit	862 (65.6)
≤6 months	329 (25)
6–12 months	64 (4.9)
>12 months	59 (4.5)
Missing data	7
Pre-bronchodilator FEV₁ % pred	72.1±20.6
Post-bronchodilator FEV₁ % pred	77.1±20.5
Pre-bronchodilator FEV₁/FVC % pred	70.2±14.4
FEV₁/FVC <70% pred	20%
FEV₁ evolution after β₂-agonists %
No evolution	243 (18.5)
Increase <10%	363 (27.1)
Increase ≥10%	304 (33.4)
Missing data	411
Exhaled nitric oxide measurements	64 (4.4)
Results ppb	37.5±26.2
Chest CT scan	754 (51.8)
Bronchiectasis	156 (22)
Bronchial wall thickening	307 (44)
Emphysema	108 (15,5)
ENT CT scan	466 (16)
Absence of clinical signs	135 (30.7)
Polyps	119 (27)
Chronic sinusitis	186 (42.3)
Missing data	26

Data are presented as n, n (%) or mean±sd. FEV₁: forced expiratory volume in 1 s; FVC: forced vital capacity; CT: computed tomography; ENT: ear, nose and throat.

TABLE 8

Medications

Subjects	1465
No LABA/ICS	22 (1.5)
Inhaled corticosteroids only^#	136 (9.3)
<500 μg·day⁻¹	21 (15.4)
500–1000 μg·day⁻¹	41 (30.1)
1000–2000 μg·day⁻¹	57 (41.9)
>2000 μg·day⁻¹	15 (11)
LABAs only	106 (7.2)
ICS/LABA combination^#	1326 (90.5)
<500 μg·day⁻¹	62 (4.7)
500–1000 μg·day⁻¹	419 (31.6)
1000–2000 μg·day⁻¹	590 (44.5)
>2000 μg·day⁻¹	253 (19.1)
Anticholinergic treatment	498 (34)
Antileukotriene (montelukast)	759 (52.2)
Long-term oral corticosteroid therapy	245 (16.8)
Mean daily dose^¶ mg	19.4±34.2
Anti-IgE (omalizumab)	390 (26.8)
Dose mg	347±155.3
Frequency of treatment
Every 2 weeks	180 (46.9)
Every 4 weeks	204 (53.1)
Missing data	6
Duration of treatment years	3.1±2.6
Theophylline	97 (6.7)
Other therapies
Long-term azithromycin	84 (5.6)
Antihistamine	655 (45)
Antidepressants	121 (8.3)
β-blocker	26 (1.8)
Anti-GORD	483 (33.2)
Postmenopausal hormone therapy	14 (1.5)
Desensitisation in the previous 5 years	54 (3.7)
Alternative medicine	84 (5.8)
Patient adherence level according to physician
High	1063 (78.5)
Medium	245 (18.1)
Low	47 (3.5)
Adherence level MMAS-4 score	3.4±1
Adherent patient (score=4)	835 (64.8)
Non-adherent patients (score <4)	454 (35.2)
Missing data	78

Data are presented as n, n (%) or mean±sd. LABA: long-acting β₂-agonist; ICS: inhaled corticosteroid; Ig: immunoglobulin; GORD: gastro-oesophageal reflux disease; MMAS-4: four-item Morisky Medication Adherence Assessment Scale. ^#: doses are presented as equivalent beclomethasone dipropionate; ^¶: doses are presented as equivalent prednisolone.

Supplementary Material
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Supplementary figure 00069-2019.supplementary_figure
Supplementary material 00069-2019.supplementary_table