Allergy Asthma Immunol Res.  2019 Jan;11(1):43-54. 10.4168/aair.2019.11.1.43.

Characteristics of Adult Severe Refractory Asthma in Korea Analyzed From the Severe Asthma Registry

Affiliations
  • 1Department of Internal Medicine, College of Medicine, Ewha Womans University, Seoul, Korea.
  • 2Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea. hjyoon@hanyang.ac.kr
  • 3Department of Allergy and Respiratory Medicine, Konkuk University Medical Center, Seoul, Korea.
  • 4Department of Pulmonary, Allergy and Critical Care Medicine, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
  • 5Department of Internal Medicine, Hallym University College of Medicine, Anyang, Korea.
  • 6Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
  • 7Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. yscho@amc.seoul.kr
  • 8Department of Internal Medicine, Kangwon National University School of Medicine, Chuncheon, Korea.
  • 9Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Korea.
  • 10Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  • 11Department of Internal Medicine, Soonchunhyang University College of Medicine, Bucheon, Korea.
  • 12Department of Internal Medicine, Chonnam National University Medical School & Hospital, Gwangju, Korea.
  • 13Department of Internal Medicine, Sungkyunkwan University School of Medicine, Seoul, Korea.
  • 14Department of Allergy and Clinical Immunology, Ajou University School of Medicine, Suwon, Korea.

Abstract

PURPOSE
Although mild to moderate asthma is much more common, the morbidity and mortality of severe asthma are much higher. This study was performed to identify and analyze the clinical characteristics of severe asthma in Korea.
METHODS
We registered patients with severe refractory asthma into the Severe Asthma Registry supported by the Severe Asthma Work Group of the Korean Academy of Asthma, Allergy and Clinical Immunology. Patients were enrolled since 2010 from the 15 university hospitals nationwide in Korea. Severe asthma was defined according to modified European Respiratory Society/American Thoracic Society criteria. Information on demographics, medical history, pulmonary function tests and skin prick tests was collected; the clinical characteristics of severe asthmatics were analyzed from the collected data.
RESULTS
A total of 489 patients were enrolled with a mean age of 62.3; 45% are male. Sixty percent of patients received Global Initiative for Asthma step 4 treatment, and 30% received step 5 treatment. The most common comorbidities were allergic rhinitis (58.7%). Aspirin hypersensitivity was observed in 14.0%. Approximately half (53.9%) are non-smokers. Atopy was proven in 38.5% of the patients. Regarding asthma medications, inhaled corticosteroids and long-acting β-agonist combination inhalers were most commonly prescribed (96.5%), followed by leukotriene antagonists (71.0%). A recombinant anti-immunoglobulin E monoclonal antibody (omalizumab) has been used in 1.8% of the patients. The mean forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and FEV1/FVC were 78.7%, 67.5% and 67.9% of predicted values, respectively. The mean Asthma Control Test and quality of life questionnaire scores were 16.5 out of 25 and 59.5 out of 85, respectively.
CONCLUSIONS
The baseline characteristics of severe asthma patients in the Korea Severe Asthma Registry were analyzed and reported for the first time. With this cohort, further prospective studies should be performed to search for ways to improve management of severe refractory asthma.

Keyword

Asthma; severe asthma; registry

MeSH Terms

Adrenal Cortex Hormones
Adult*
Allergy and Immunology
Aspirin
Asthma*
Cohort Studies
Comorbidity
Demography
Forced Expiratory Volume
Hospitals, University
Humans
Hypersensitivity
Korea*
Leukotriene Antagonists
Male
Mortality
Nebulizers and Vaporizers
Prospective Studies
Quality of Life
Respiratory Function Tests
Rhinitis, Allergic
Skin
Vital Capacity
Adrenal Cortex Hormones
Aspirin
Leukotriene Antagonists

Figure

  • Fig. 1 The composition of ICS types (A). The percentage of use of other controllers or rescue medication (B). ICS, inhaled corticosteroids; LTRA, leukotriene receptor antagonist; IgE, immunoglobulin E; Ab, antibody.

  • Fig. 2 The percentage of patients who visited a healthcare facility unexpectedly (A) and the percentage of patients who were prescribed systemic corticosteroids burst treatment (B). ER, emergency room; ICU, intensive care unit.


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