Severe asthma care trajectories: the French RAMSES cohort

Jeanne-Marie Perotin^{1

2

3}, Lisa Gauquelin⁴, Nicolas Just⁵, Gilles Devouassoux^{3

6}, Cécile Chenivesse^{2

7}, Arnaud Bourdin⁸, Gilles Garcia⁹, Christel Saint Raymond¹⁰, Amel Boudjemaa¹¹, Philippe Bonniaud^{2

12

13}, Pascal Chanez^{14

15}, Cindy Barnig^{2

16}, Antoine Beurnier¹⁷, Cyril Maurer¹⁸, Nathalie Freymond¹⁹, Toufik Didi²⁰, Colas Tcherakian²¹, Maud Russier²², Mélanie Drucbert^{23

24}, Sylvie Guillo²⁵, Candice Estellat²⁵, Camille Taillé^{26

27}

Affiliations

¹ Department of Respiratory Diseases, University Hospital of Reims, Reims, France.
² University of Reims Champagne-Ardenne, Inserm UMR-S 1250, SFR Cap-Santé, Reims, France.
³ CRISALIS/F-CRIN INSERM Network, France.
⁴ AP-HP, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.
⁵ Respiratory Diseases Department, Victor Provo Hospital, Roubaix, France.
⁶ Service de Pneumologie, CIERA, Hôpital de la Croix Rousse, GHN, HCL, VIRPATH, Université Claude Bernard Lyon 1, Lyon, France.
⁷ Université de Lille, CNRS, Inserm, CHU Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, Lille, France.
⁸ Université de Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France.
⁹ Service de Pneumologie, Hôpital Privé d'Antony, Antony, France.
¹⁰ Service de Pneumologie, CHU Grenoble Alpes, Grenoble, France.
¹¹ Service de Pneumologie, CHI de Créteil, Créteil, France.
¹² Department of Respiratory Diseases and Intensive Care, Dijon-Bourgogne University Hospital, Dijon, France.
¹³ University of Burgundy, Inserm UMR1231, Dijon, France.
¹⁴ Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France.
¹⁵ AP-HM, Hôpital Nord, Clinique des Bronches, de l'Allergie et du Sommeil, Marseille, France.
¹⁶ Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, Besançon, France.
¹⁷ Department of Physiology - Functional Explorations, bi-site Hôpital Bicêtre (Le Kremlin-Bicêtre) and Ambroise Paré (Boulogne-Billancourt), DMU 5 Thorinno, AP-HP, Université Paris-Saclay, INSERM UMR_S 999, Paris, France.
¹⁸ Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
¹⁹ Respiratory Diseases and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France.
²⁰ Service de Pneumologie, CH Annecy Genevois, Metz-Tessy, France.
²¹ Department of Respiratory Diseases, Foch Hospital, Suresnes, France.
²² Pneumo-allergology Department, Orléans Regional Hospital Center, Orléans, France.
²³ Department of Respiratory Disease, University Hospital of Amiens, Amiens, France.
²⁴ University of Picardie Jules Verne, Amiens, France.
²⁵ Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique - IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Cephepi, Paris, France.
²⁶ Department of Respiratory Diseases, Reference Center for Rare Pulmonary Diseases, Bichat Hospital, AP-HP, Paris, France.
²⁷ INSERM UMR 1152, University of Paris Cité, Paris, France.

PMID: 38651091
PMCID: PMC11033728
DOI: 10.1183/23120541.00837-2023

Severe asthma care trajectories: the French RAMSES cohort

Jeanne-Marie Perotin et al. ERJ Open Res. 2024.

. 2024 Apr 22;10(2):00837-2023.

doi: 10.1183/23120541.00837-2023. eCollection 2024 Mar.

Authors

Affiliations

¹ Department of Respiratory Diseases, University Hospital of Reims, Reims, France.
² University of Reims Champagne-Ardenne, Inserm UMR-S 1250, SFR Cap-Santé, Reims, France.
³ CRISALIS/F-CRIN INSERM Network, France.
⁴ AP-HP, Centre de Pharmacoépidémiologie (Cephepi), Paris, France.
⁵ Respiratory Diseases Department, Victor Provo Hospital, Roubaix, France.
⁶ Service de Pneumologie, CIERA, Hôpital de la Croix Rousse, GHN, HCL, VIRPATH, Université Claude Bernard Lyon 1, Lyon, France.
⁷ Université de Lille, CNRS, Inserm, CHU Lille, U1019 - UMR 9017 - Center for Infection and Immunity of Lille, Lille, France.
⁸ Université de Montpellier, PhyMedExp, INSERM, CNRS, Montpellier, France.
⁹ Service de Pneumologie, Hôpital Privé d'Antony, Antony, France.
¹⁰ Service de Pneumologie, CHU Grenoble Alpes, Grenoble, France.
¹¹ Service de Pneumologie, CHI de Créteil, Créteil, France.
¹² Department of Respiratory Diseases and Intensive Care, Dijon-Bourgogne University Hospital, Dijon, France.
¹³ University of Burgundy, Inserm UMR1231, Dijon, France.
¹⁴ Aix-Marseille Université, INSERM, INRAE, C2VN, Marseille, France.
¹⁵ AP-HM, Hôpital Nord, Clinique des Bronches, de l'Allergie et du Sommeil, Marseille, France.
¹⁶ Université de Franche-Comté, CHU Besançon, EFS, INSERM, UMR RIGHT, Besançon, France.
¹⁷ Department of Physiology - Functional Explorations, bi-site Hôpital Bicêtre (Le Kremlin-Bicêtre) and Ambroise Paré (Boulogne-Billancourt), DMU 5 Thorinno, AP-HP, Université Paris-Saclay, INSERM UMR_S 999, Paris, France.
¹⁸ Groupe Hospitalier Intercommunal Le Raincy-Montfermeil, Montfermeil, France.
¹⁹ Respiratory Diseases and Thoracic Oncology Department, Lyon Sud Hospital, Hospices Civils de Lyon, Lyon, France.
²⁰ Service de Pneumologie, CH Annecy Genevois, Metz-Tessy, France.
²¹ Department of Respiratory Diseases, Foch Hospital, Suresnes, France.
²² Pneumo-allergology Department, Orléans Regional Hospital Center, Orléans, France.
²³ Department of Respiratory Disease, University Hospital of Amiens, Amiens, France.
²⁴ University of Picardie Jules Verne, Amiens, France.
²⁵ Sorbonne Université, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique - IPLESP, AP-HP, Hôpital Pitié Salpêtrière, Cephepi, Paris, France.
²⁶ Department of Respiratory Diseases, Reference Center for Rare Pulmonary Diseases, Bichat Hospital, AP-HP, Paris, France.
²⁷ INSERM UMR 1152, University of Paris Cité, Paris, France.

PMID: 38651091
PMCID: PMC11033728
DOI: 10.1183/23120541.00837-2023

Abstract

Background: The French RAMSES study is an observational prospective multicentre real-life cohort including severe asthmatic subjects. The objective of the study was to compare the characteristics of patients, in terms of phenotype and asthma care trajectories, between those managed by tertiary referral centres (TRCs) or secondary care centres (SCCs).

Methods: Patients were prospectively recruited and enrolled for a 5-year follow-up. Patients' characteristics were analysed at inclusion and compared between TRCs and SCCs.

Results: 52 centres (24 TRCs and 28 SCCs) included 2046 patients: 1502 (73.4%) were included by a TRC and 544 (26.6%) by a SCC. Patients were mainly women (62%), 53±15 years old, 67% with Asthma Control Test <20; at inclusion, 14% received oral corticosteroids (OCS) and 66% biologics. Compared with the SCC group, the TRC group had more frequent comorbidities and lower blood eosinophil counts (262 versus 340 mm^-3; p=0.0036). OCS and biologics use did not differ between groups, but patients in the TRC group benefited more frequently from an educational programme (26% versus 18%; p=0.0008) and received more frequently two or more sequential lines of biologics (33% versus 24%; p=0.0105). In-depth investigations were more frequently performed in the TRC group (allergy tests: 74% versus 62%; p<0.0001; exhaled nitric oxide fraction: 56% versus 21%; p<0.0001; induced sputum: 6% versus 3%; p=0.0390).

Conclusions: Phenotypes and care trajectories differed in the RAMSES cohort between SCCs and TRCs, probably related to different levels of asthma severity and differences in medical resources and practices among centres. This highlights the need for standardisation of severe asthma care.

PubMed Disclaimer

Conflict of interest statement

Conflict of interest: J-M. Perotin reports lecture honoraria from AstraZeneca, support for attending meetings from AstraZeneca and Chiesi, and membership of working groups and associations receiving financial support from AstraZeneca, Chiesi, Novartis and Sanofi; outside the submitted work. N. Just participated or participates as an investigator in clinical trials with Chiesi, and reports honoraria from Chiesi and AstraZeneca. G. Devouassoux reports lecture honoraria from AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Mundi Pharma, Novartis Pharma, Vivisol, Sanofi, ALK and Menarini; consultancy fees from AGIR Adom, ALK, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Meda, MSD, Novartis Pharma, Orkyn, Takeda, TEVA, Sanofi and Cipla; has served as a principal investigator and/or study coordinator for AB Science, ALK, Amgen, AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Lilly, Novartis Pharma, Roche, Regeneron Pharmaceuticals Inc., Sanofi, TEVA, VitalAire, Gossamer and Zambon; and reports research grants from AGIR Adom, ALLP, Chiesi, GlaxoSmithKline, MSD, Novartis Pharma, Orkyn, Takeda and Vivisol. C. Chenivesse reports grants from AstraZeneca, GlaxoSmithKline, Novartis and Santelys, personal fees from ALK-Abello, AstraZeneca, Boehringer Ingelheim, Chiesi, GlaxoSmithKline and Sanofi, and congress support from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and Sanofi. C. Saint Raymond reports lecture honoraria, support for attending meetings, and membership of working groups and associations receiving financial support from AstraZeneca, Novartis, GlaxoSmithKline and Sanofi. A. Bourdin reports grants from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, AB Science, Celltrion, Cipla, Areteia, Novartis, Sanofi Regeneron and Chiesi, consulting fees, lecture fees and support for meetings from Boehringer Ingelheim, AstraZeneca, GlaxoSmithKline, AB Science, Celltrion, Cipla, Novartis, Sanofi Regeneron and Chiesi, and participation on an advisory board for AB Science. G. Garcia reports personal fees from AstraZeneca, Sanofi, Novartis, Chiesi and GlaxoSmithKline, and congress support from Sanofi and Oxyvie. A. Boudjemaa reports personal fees from AstraZeneca, Sanofi, Chiesi and GlaxoSmithKline, and congress support from GlaxoSmithKline and Oxyvie. P. Bonniaud reports research grants from AstraZeneca, personal fees from AstraZeneca, Boehringer Ingelheim, Sanofi, Novartis and GlaxoSmithKline, and congress support from AstraZeneca, Sanofi, Boehringer Ingelheim, Stallergenes and Novartis. P. Chanez reports grants, consulting fees, lectures fees and support for meetings from ALK, AstraZeneca, Biopharm, Boehringer Ingelheim, Chiesi, GlaxoSmithKline, Novartis and Sanofi-Aventis. C. Barnig reports support for attending meetings from AstraZeneca, GlaxoSmithKline, Sanofi, ALK and Chiesi. A. Beurnier reports lecture fees from AstraZeneca and Sanofi. N. Freymond reports lecture honoraria from AstraZeneca, Sanofi and GlaxoSmithKline, and support for attending meetings from AstraZeneca and Sanofi; outside the submitted work. C. Tcherakian reports a grant from Air Liquide Foundation, lecture fees from AstraZeneca, GlaxoSmithKline, Chiesi, Novartis and Sanofi, and meeting support from Sanofi and GlaxoSmithKline. M. Drucbert reports lecture honoraria from GlaxoSmithKline and AstraZeneca, and membership of working group receiving financial support from AstraZeneca; outside the submitted work. S. Guillo reports no personal fees, congress support or research grants with conflicting interests to disclose other than the funding of the RAMSES cohort. C. Estellat reports no personal fees, congress support or research grants with conflicting interests to disclose other than the funding of the RAMSES cohort. C. Taillé reports lecture or advisory board fees and grants from AstraZeneca, Sanofi, GlaxoSmithKline, Chiesi, Stallergenes and Novartis. All other authors have nothing to declare. There are no further conflicting interests to disclose.

Figures

**FIGURE 1**
Distance between the patient's home and inclusion centre for a) tertiary referral centres (TRCs) and b) secondary care centres (SCCs) in metropolitan France.

See this image and copyright information in PMC

References

1. GBD 2019 Diseases and Injuries Collaborators . Global burden of 369 diseases and injuries in 204 countries and territories, 1990–2019: a systematic analysis for the Global Burden of Disease Study 2019. Lancet 2020; 396: 1204–1222. doi:10.1016/S0140-6736(20)30925-9 - DOI - PMC - PubMed
1. Chung KF, Wenzel SE, Brozek JL, et al. . International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J 2014; 43: 343–373. doi:10.1183/09031936.00202013 - DOI - PubMed
1. Kupczyk M, Wenzel S. U.S. and European severe asthma cohorts: what can they teach us about severe asthma? J Intern Med 2012; 272: 121–132. doi:10.1111/j.1365-2796.2012.02558.x - DOI - PubMed
1. Paoletti G, Pepys J, Casini M, et al. . Biologics in severe asthma: the role of real-world evidence from registries. Eur Respir Rev 2022; 31: 210278. doi:10.1183/16000617.0278-2021 - DOI - PMC - PubMed
1. van Bragt JJMH, Adcock IM, Bel EHD, et al. . Characteristics and treatment regimens across ERS SHARP severe asthma registries. Eur Respir J 2020; 55: 1901163. doi:10.1183/13993003.01163-2019 - DOI - PubMed

LinkOut - more resources

Full Text Sources
- Europe PubMed Central
- PubMed Central
Research Materials
- NCI CPTC Antibody Characterization Program

Save citation to file

Email citation

Add to Collections

Add to My Bibliography

Your saved search

Create a file for external citation management software

Your RSS Feed

Severe asthma care trajectories: the French RAMSES cohort

Affiliations

Severe asthma care trajectories: the French RAMSES cohort

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

LinkOut - more resources

Full Text Sources

Research Materials