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. 2021 Nov 19;14(11):100606.
doi: 10.1016/j.waojou.2021.100606. eCollection 2021 Nov.

Severe asthma: One disease and multiple definitions

Diego Bagnasco  1 , Pierluigi Paggiaro  2 , Manuela Latorre  2   3 , Chiara Folli  1 , Elisa Testino  1 , Arianna Bassi  1 , Manlio Milanese  4 , Enrico Heffler  5 , Andrea Manfredi  1 , Anna Maria Riccio  1 , Laura De Ferrari  1 , Francesco Blasi  6   7 , Rikki Frank Canevari  8   9 , Giorgio Walter Canonica  5 , Giovanni Passalacqua  1 ; SANI (Severe Asthma Network Italy); Severe Asthma Network Italy
Collaborators, Affiliations

Severe asthma: One disease and multiple definitions

Diego Bagnasco et al. World Allergy Organ J. .

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.

Keywords: Biological treatment; Classification; Definition; Severe asthma.

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Conflict of interest statement

None to declare.

Figures

Fig. 1
Fig. 1
Distribution of the patients of the Severe Asthma Network Italy using the different definitions.
Fig. 2
Fig. 2
Different distribution in Venn diagram of the Italian SANI patients among guidelines groups (A) and clinical trials definitions (B).
See this image and copyright information in PMC

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