Systematic assessment for difficult and severe asthma improves outcomes and halves oral corticosteroid burden independent of monoclonal biologic use.

Abstract Background Guidelines endorse systematic assessment for severe asthma, with data indicating benefit across multiple outcome domains. Objective We examined which patients respond to systematic assessment and whether oral corticosteroid burden can be decreased independent of monoclonal biologic use. Methods Specialist-referred patients are assessed systematically for difficult asthma at our centre. We undertook a responder analysis for improvements in the domains of symptom control, quality of life, exacerbations and airflow obstruction, assessed six months after initial assessment. Multivariate analyses were performed for each domain to identify predictors of response. Changes in oral corticosteroid burden were also measured, stratified by monoclonal biologics commenced during assessment. Results Among 161 patients assessed systematically, 64% had a reduction in exacerbations, 54% achieved minimum clinically important differences for both symptom control and quality of life, and 40% increased their FEV1 by ≥ 100 ml. Altogether, 87% of asthma patients improved in at least one domain. The most consistent predictor of response across domains was poorer baseline asthma status. There was a substantial reduction in mean chronic oral corticosteroid dose (11 mg to 5 mg, n=46, p Conclusion Almost 90% of patients undergoing systematic assessment for difficult asthma improve significantly in at least one key asthma outcome, with few reliable predictors of response. The halving of oral corticosteroid burden during systematic assessment is independent of, and comparable in magnitude to, that achieved by monoclonal biologics.