Evaluation of Asthma control and oral corticosteroids in Severe Asthma

Introduction: Severe asthma (SA) has relevant pharmacological and socio-economic impact. Besides an adequate inhalation therapy, patients frequently require oral corticosteroids (OCS) for asthma control. However, log-term OCS use is associated with adverse effects. Aim: We assessed asthma control and the characteristics of patients treated with OCS in Allergy and Pulmonology Departments adhering to the Italian Registry of Severe Asthma (IRSA). Methods: IRSA is an Italian, multicenter, transversal/retrospective, non-interventional, observational study on patients ≥14years affected by SA according to GINA Guidelines. Data on asthma control and patients regularly treated with OCS were analysed. Results: Overall, 1216 patients (477 male, 739 female) were included in the analysis. According to the Asthma Control Test scoring, 409 patients were controlled with a mean FEV1 78±21%. As add-on to inhalation therapy, 383 patients took OCS: Dexamethasone 0.7%, Deflazacort 1.6%, Betamethasone 2.7%, Methylprednisolone 8.5%, Prednisone 17.6%. Among patients, 15% treated with OCS were controlled and 40% were uncontrolled asthmatics. Patients with uncontrolled asthma had high eosinophilia (577cells/ul ± 800) compared with controlled (432cells/ul ± 632). Moreover, patients with eosinophilia (n=675) took OCS in 34.5% of cases, and only 60% were treated with biologics. Conclusions: Despite high-dose inhalation therapy plus additional controllers or OCS, only 34% of patients affected by SA had controlled asthma. Moreover, 31% of subjects daily took OCS. Of note, uncontrolled patients had a high eosinophilia and few were properly treated with biologics.