Patient-reported trigger number is a strong predictor of uncontrolled disease among patients with severe asthma

IntroductionSevere asthma (SA) is associated with high morbidity. Numerous factors can trigger or exacerbate asthma symptoms and attacks through interactions with the airway epithelium. A better understanding of triggers among SA patients could help improve care.MethodsCHRONICLE is an observational study of adults with SA receiving biologics, maintenance systemic corticosteroids (SCS), or uncontrolled on high-dosage inhaled corticosteroids and additional controllers. For patients enrolled February 2018–February 2021, this analysis examined associations between the number of patient-reported triggers (from a 17-category survey) and disease control (Asthma Control Test [ACT], work productivity, Saint George's Respiratory Questionnaire [SGRQ], HCP-reported exacerbations). Multivariate analyses further examined associations between disease control and trigger number or blood eosinophil counts [BEC].ResultsAmong 2847 enrolled patients, 1434 (51.3%) completed the triggers questionnaire. Median trigger number per patient was 8 (IQR: 5, 10). Most common triggers were weather/air changes, viral infections, seasonal allergies, perennial allergies, and exercise. Patients reporting more triggers experienced more poorly controlled disease, worse quality of life, reduced work productivity, and more exacerbations (Figure), which was confirmed by multivariate models. For all measures, trigger number was a stronger predictor than BEC. AUC-ROC for trigger number was higher than for BEC for predicting ≥1 exacerbations and ≥1 asthma hospitalizations (0.60 vs. 0.53 and 0.67 vs. 0.51, respectively).ConclusionAmong US specialist-treated patients with SA, number of patient-reported triggers was a better predictor than BEC of disease morbidity across multiple measures. This highlights the importance of understanding patient-reported triggers in SA treatment.