More Than a Decade Follow-up in Severe or Difficult-to-Treat Asthma: TENOR II

Publication date: Available online 7 August 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Bradley E. Chipps, Tmirah Haselkorn, Brandee Paknis, Benjamin Ortiz, Eugene R. Bleecker, Farid Kianifard, Aimee J. Foreman, Stanley J. Szefler, Robert S. Zeiger
BackgroundThe Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR I) study demonstrated high morbidity in patients with severe/difficult-to-treat asthma, despite standard-of-care treatment.ObjectiveTo determine the long-term natural history of disease and outcomes in patients in TENOR I, after more than a decade.MethodsTENOR I was a multicenter, observational study (2001–2004) of 4756 patients with severe/difficult-to-treat asthma. TENOR II was a follow-up study of TENOR I patients using a single, cross-sectional visit in 2013/2014. Overall, the sites participating in TENOR II originally enrolled 1230 patients in TENOR I. Clinical and patient-reported outcomes were assessed, including very poorly controlled (VPC) asthma based on National Heart, Lung, and Blood Institute (NHLBI) guidelines.ResultsA total of 341 (27.7%) patients were enrolled in TENOR II and were representative of the TENOR I cohort. Most frequent comorbidities were rhinitis (84.0%), sinusitis (47.8%) and gastroesophageal reflux disease (46.3%). Mean (SD) percent predicted pre- and post-bronchodilator FEV1 were 72.7% (21.4%) and 78.2% (20.7%), respectively. A total of 231/317 (72.9%) tested positive for ≥1 allergen-specific IgE. Mean (SD) blood eosinophil count was 200 μL (144). Eighty-eight (25.8%) patients experienced an asthma exacerbation in the prior 3 months requiring hospital attention and/or oral corticosteroids. Over half (197/339; 58.1%) had VPC asthma. Medication use suggested undertreatment.ConclusionTENOR II provides longitudinal data to characterize disease progression, heterogeneity and severity in severe/difficult-to-treat asthma. Findings show continued morbidity, including a high degree of comorbid conditions, allergic sensitization, exacerbations and VPC asthma, including reduced lung function.

Teaser

More than a decade after TENOR I, substantial disease burden, including high rates of comorbidities, allergic sensitization, poorly controlled asthma, and exacerbations were observed in patients with severe or difficult-to-treat asthma in TENOR II, despite standard-of-care therapy.


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