New scoring systems could help improve severe asthma treatment
Southampton researchers have developed the first patient-centred tools to assess severe asthma treatment.
Severe asthma affects around 5-10% of patients with asthma. It can have a significant impact on quality of life, with many patients missing school or work due to the condition.
Building understanding of the latest treatments could help improve patient care.
The research team have created scoring systems for adults and children with severe asthma. They invited international healthcare professionals (HCPs) and patients to take part in their development. These groups each shared which responses to treatment they think are most important.
Dr Ekaterina Khaleva from the University of Southampton led the study. She is part of the NIHR Southampton Biomedical Research Centre (BRC). The study was undertaken within the European Union funded 3TR project.
The team published their findings in the European Respiratory Journal.
Treating severe asthma
Biologics can treat some types of severe asthma.
These are antibody-based treatments that are usually given as an injection. They can improve asthma control and reduce the frequency of asthma attacks.
The downside of biologics is that they are burdensome for patients. They are also more expensive for the NHS than other treatments.
People receiving biologics are closely monitored to ensure that they are receiving the right treatment to help manage their symptoms. However, there are no patient-centred tools to measure their response.
Building on previous work
A previous Southampton-led study developed Core Outcome Measures for Severe Asthma (COMSA).
These are a set of tools that should be used in all studies about a specific topic. They allow researchers to compare results between studies more easily. This helps them to identify the most effective treatments.
Building on this, researchers have now developed paediatric and adult CompOsite iNdexes For Response in asthMa (CONFiRM).
A composite index combines multiple outcome measures into a single score. This provides a better assessment of patient response and treatment effectiveness.
Dr Khaleva, an NIHR Academic Clinical Fellow in Paediatrics, said:
“CONFiRM scores will help evaluate response to severe asthma treatment in a valid, standardised manner.
“Previously there has been no agreed definition of improvement or deterioration, nor standardised terms for different response levels. Existing scoring systems focus only on adults and lack patient input and quality of life measures.
“Working with an international team, we developed a composite index that standardises assessment. This ensures a more detailed and patient-centred approach to evaluating treatment response in children and adults with severe asthma.”
People living with severe asthma were at the heart of this research. One participant said:
“Biologics are seen as the go-to treatments. Being able to quantify what a response to treatment looks like will make it easier for those for whom they do not work. Rather than staying on a treatment that "might" be working, doctors and patients can gauge the level of response and react appropriately.”
Patient-centred research
CONFiRM incorporates severe asthma exacerbations and other outcome measures selected in the COMSA. They were weighted according to their relative importance in defining response by patient advocates and HCPs.
By taking this approach, researchers addressed the gaps in previous efforts to define response and non-response to biologics, putting patients with severe asthma at the centre.
A total of 147 expert HCPs and patient advocates from more than 25 countries completed the adult and paediatric surveys.
The results were similar between the two groups. However, patients placed greater importance on asthma-specific quality of life than HCPs did.
Severe exacerbations and maintenance oral corticosteroid use were rated as the most important factors in determining treatment response.
Prof Graham Roberts is Professor of Paediatric Allergy and Respiratory Medicine at UoS. He also co-leads the Respiratory and Allergy theme at the NIHR Southampton BRC. Prof Roberts said:
“CONFiRM has been developed by an international group of clinicians and patients. This means that it should be applicable around the world and relevant to both clinicians and patients.
“The tool will help quantify the response of severe asthma to treatment. This will support clinicians and patients to make the best decisions about their future care.
“As a validated outcome measure, CONFiRM can also be used to provide a holistic view of new treatment success in clinical trials.”
Prof Chris Brightling is Professor of Respiratory Medicine at the University of Leicester. He is also the respiratory lead for the 3TR programme. Prof Brightling said:
“The 3TR programme is leading our understanding of response to biologic therapy in severe asthma. CONFiRM will allow us to standardise the way we measure response in trials that have already been completed. It will also be a useful tool in future clinical trials and real-world studies of severe asthma.”