Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.

Severe asthma: One disease and multiple definitions / Bagnasco, D; Paggiaro, P; Latorre, M; Folli, C; Testino, E; Bassi, A; Milanese, M; Heffler, E; Manfredi, A; Riccio, Am; De Ferrari, L; Blasi, F; Canevari, Rf; Canonica, Gw; Passalacqua, G; Guarnieri, G; Patella, V; Maria Pia, Fb; Carpagnano, Ge; Colle, Ad; Scioscia, G; Gerolamo, P; Puggioni, F; Racca, F; Favero, E; Iannacone, S; Savi, E; Montagni, M; Camiciottoli, G; Allegrini, C; Lombardi, C; Spadaro, G; Detoraki, C; Menzella, F; Galeone, C; Ruggiero, P; Yacoub, M; Berti, A; Scichilone, N; Durante, C; Costantino, Mt; Roncallo, C; Braschi, M; D'Adda, A; Ridolo, E; Triggiani, M; Parente, R; Maria, Da; Verrillo, Mv; Rolla, G; Brussino, L; Frazzetto, Av; Cristina, Zm; Lilli, M; Crimi, N; Bonavia, M; Corsico, Ag; Grosso, A; Del Giacco, S; Deidda, M.; Ricciardi, L.; Isola, S.; Cicero, F.; Amato, G.; Vita, F.; Spanevello, A.; Pignatti, P.; Cherubino, F.; Visca, D.; Massimo Ricciardolo, F. L.; Anna Carriero, V. M.; Bertolini, F.; Santus, P.; Barlassina, R.; Airoldi, A.; Guida, G.; Eleonora, N.; Aruanno, A.; Rizzi, A.; Caruso, C.; Colantuono, S.; Senna, G.; Caminati, M.; Arcolaci, A.; Vianello, A.; Bianchi, F. C.; Marchi, M. R.; Centanni, S.; Luraschi, S.; Ruggeri, S.; Rinaldo, R.; Parazzini, E.; Calabrese, C.; Flora, M.; Cosmi, L.; Di Pietro, L.; Maggi, E.; Pini, L.; Macchia, L.; Di Bona, D.; Richeldi, L.; Condoluci, C.; Fuso, L.; Bonini, M.; Farsi, A.; Carli, G.; Montuschi, P.; Santini, G.; Conte, M. E.; Turchet, E.; Barbetta, C.; Mazza, F.; D'Alo, S.; Pucci, S.; Caiaffa, M. F.; Minenna, E.; D'Elia, L.; Pasculli, C.; Viviano, V.; Tarsia, P.; Rolo, J.; Di Proietto, M.; Lo Cicero, S.. - In: THE WORLD ALLERGY ORGANIZATION JOURNAL. - ISSN 1939-4551. - 14:11(2021). [10.1016/j.waojou.2021.100606]

Severe asthma: One disease and multiple definitions

Blasi F;Yacoub M;Carli G.;
2021-01-01

Abstract

Introduction There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.
2021
Severe asthma, Classification, Definition, Biological treatment
File in questo prodotto:
File Dimensione Formato  
PIIS1939455121001009.pdf

accesso aperto

Tipologia: PDF editoriale (versione pubblicata dall'editore)
Licenza: Creative commons
Dimensione 423.5 kB
Formato Adobe PDF
423.5 kB Adobe PDF Visualizza/Apri

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11768/152051
Citazioni
  • ???jsp.display-item.citation.pmc??? ND
  • Scopus 25
  • ???jsp.display-item.citation.isi??? 24
social impact