LAUSR

Introduction Among asthma patients who remain uncontrolled despite use of high-dose inhaled corticosteroids (ICS) plus a second controller medication or oral corticosteroid (OCS) dependent asthma patients, the latest Global Initiative on Asthma (GINA) guidance characterizes type 2 inflammation (T2) with biomarkers, such as blood eosinophils (EOS) or fractional exhaled nitric oxide (FeNO), and atopy. Some comorbidities, such as chronic rhinosinusitis with nasal polyps (CRSwNP) or atopic dermatitis (AD) should also be considered in determining add-on biologic T2-targeted treatment1 This study estimated the proportion of uncontrolled, high-dose ICS asthma patients in Latin America based on T2 comorbidities, exacerbation history and biomarkers. Methods A cross-sectional survey of physicians was conducted between June 6, 2018 and July 18, 2018. Pulmonologists, allergists and general practitioners from Colombia, Brazil, and Mexico reported data from medical records of a convenience sample of their six most recent patients age 12+ years. This analysis described the uncontrolled severe asthma population in terms of OCS use, number of exacerbations in past year, EOS level, FeNO and T2 asthma-related comorbidities. Results 320 uncontrolled severe asthma patients age 12+ on a high-dose ICS regimen plus at least one controller were included (Brazil=113, Mexico=109, Colombia=98) (table 1). Conclusions A high proportion of severe asthma patients had evidence of T2 asthma as reflected by the proportion of patients having allergic rhinitis, nasal polyposis and atopic dermatitis, and based on EOS and FeNO results. Additionally, a third of patients had experienced two or more exacerbations in the past year. Reference Difficult-To-Treat & Severe Asthma in Adolescent and Adult Patients. Global Initiative for Asthma (GINA), 2019. Available from www.ginasthma.org Date last updated. 2019Abstract P153 Table 1 Pooled n (%) Brazil n (%) Mexico n (%) Colombia n (%) Uncontrolled severe asthma patients age 12+ on high-dose ICS plus ≥ 1 controller N 320 (100) 113 (100) 109 (100) 98 (100) Type 2 asthma-related comorbidities Atopic Dermatitis 65 (20) 20 (18) 23 (21) 22 (22) Nasal Polyposis 49 (15) 14 (12) 22 (20) 13 (13) Allergic Rhinitis 219 (68) 82 (73) 73 (67) 64 (65) Exacerbations* 2+ exacerbations in past year 106 (33) 34 (30) 38 (35) 34 (35) 3+ exacerbations in past year 48 (15) 15 (13) 18 (17) 15 (15) 4+ exacerbations in past year 28 (9) 10 (9) 9 (8) 9 (9) OCS use Chronic 40 (13) 8 (7) 19 (7) 13 (13) Biomarkers (among patients with lab values) EOS ≥ 150 cells/µL† 83/136 (61) 22/39 (56) 35/49 (71) 26/48 (54) EOS ≥ 300 cells/µL† 59/136 (43) 15/39 (38) 32/49 (65) 12/48 (25) EOS ≥ 400 cells/µL† 41/136 (30) 8/39 (21) 25/49 (51) 8/48 (17) FeNO ≥ 25 ppb‡ 12/12 (100) 10/10 (100) 1/1 (100) 1/1 (100) IgE 30 -1500 IU/mL 152/173 (88) 44/50 (88) 63/66 (95) 45/57 (79) 150 cells/µL ≤ EOS ≤ 300 cells/µL 33/136 (24) 10/39 (26) 8/49 (16) 15/48 (31) * Direct question to physicians †Regardless of other biomarker levels ‡Limited FeNO lab data available