Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Observational Study
. 2022 Aug 24;12(8):e060160.
doi: 10.1136/bmjopen-2021-060160.

Real-life impact of uncontrolled severe asthma on mortality and healthcare use in adolescents and adults: findings from the retrospective, observational RESONANCE study in France

Nicolas Roche  1 , Gilles Garcia  2 , Alexandre de Larrard  3 , Charlotte Cancalon  3 , Stève Bénard  3 , Vincent Perez  4 , Aymeric Mahieu  4 , Laurine Vieu  4 , Pascal Demoly  5
Affiliations
Observational Study

Real-life impact of uncontrolled severe asthma on mortality and healthcare use in adolescents and adults: findings from the retrospective, observational RESONANCE study in France

Nicolas Roche et al. BMJ Open. .

Abstract

Objective: To characterise uncontrolled severe asthma and compare the disease burden with the general and asthmatic populations.

Design: Retrospective observational study using a national sample of a French healthcare database (Echantillon Généraliste des Bénéficiaires (EGB)).

Setting: The EGB, an anonymised permanent sample of health insurance databases, representing 1/97th of the French population.

Participants: Patients (≥12 years) were selected in year 2014 and followed 2 years. A cohort of patients with uncontrolled severe asthma was defined using an algorithm based on peer-reviewed literature and Global Initiative for Asthma recommendations. Index date was the occurrence of the first marker of uncontrolled asthma. This cohort was matched with two control cohorts, general population and asthmatic controls, on baseline characteristics.

Main outcomes measures: Mortality, healthcare use and associated costs were studied in the 2 years of follow-up.

Results: Among 467 716 individuals in the EGB, 16 588 patients with asthma were identified, including 739 (4.5%) with uncontrolled severe disease. The survival probability at 2 years for patients with uncontrolled severe asthma (92.0%) was lower than in the general population cohort (96.6%; relative risk of death: 2.35; 95% CI: 1.70 to 3.29; p<0.0001) and tended to be lower than in the control asthmatic cohort (94.3%; p=0.07). Emergency department visits and hospitalisations were higher in patients with uncontrolled severe asthma than in the general population (64.7% vs 34.9%; p<0.0001) and asthmatic controls (64.7% vs 55.2%; p=0.0002). Other components of healthcare use (medical and paramedical visits, medications) were increased in patients with uncontrolled severe asthma compared with control populations. These increases translated into higher costs (p<0.0001 for both comparisons).

Conclusions: This study demonstrates the huge burden of uncontrolled severe asthma in terms of mortality, morbidity and healthcare resource consumption compared with other patients with asthma and with the general population and emphasises the importance of appropriate management in this high-risk population.

Keywords: Asthma; Epidemiology; HEALTH ECONOMICS.

PubMed Disclaimer

Conflict of interest statement

Competing interests: PD has received honoraria and/or research grants from ALK, Mylan-Viatris, Stallergenes, ThermoFisher Scientific, AstraZeneca, GSK, Novartis, Menarini and Regeneron. GG has received honoraria from ALK, Novartis, AstraZeneca, GSK, Sanofi and Chiesi for conferences or advisory board meetings. NR has received research funding from Boehringer Ingelheim, GSK, Pfizer and Novartis and honoraria from Boehringer Ingelheim, Pfizer, Novartis, Teva, GSK, AstraZeneca, Chiesi, Sanofi and Zambon. LV, AM, VP are Sanofi employee and may hold shares and/or stock options in the company. No other disclosures were reported.

Figures

Figure 1
Figure 1
RESONANCE study design.
Figure 2
Figure 2
24-Month survival for the uncontrolled severe asthmatic cohort versus general population and asthmatic control cohorts.
See this image and copyright information in PMC

References

    1. Busse WW, Banks-Schlegel S, Wenzel SE. Pathophysiology of severe asthma. J Allergy Clin Immunol 2000;106:1033–42. 10.1067/mai.2000.111307 - DOI - PubMed
    1. Israel E, Reddel HK, Severe RHK. Severe and difficult-to-treat asthma in adults. N Engl J Med 2017;377:965–76. 10.1056/NEJMra1608969 - DOI - PubMed
    1. Yaghoubi M, Adibi A, Safari A, et al. . The projected economic and health burden of uncontrolled asthma in the United States. Am J Respir Crit Care Med 2019;200:1102–12. 10.1164/rccm.201901-0016OC - DOI - PMC - PubMed
    1. O'Neill S, Sweeney J, Patterson CC, et al. . The cost of treating severe refractory asthma in the UK: an economic analysis from the British thoracic Society difficult asthma registry. Thorax 2015;70:376–8. 10.1136/thoraxjnl-2013-204114 - DOI - PubMed
    1. Godard P, Chanez P, Siraudin L, et al. . Costs of asthma are correlated with severity: a 1-yr prospective study. Eur Respir J 2002;19:61–7. 10.1183/09031936.02.00232001 - DOI - PubMed

Publication types