Factors associated with reduced asthma severity and improved asthma control in the severe asthma research program 3

SESSION TITLE: Personalized Medicine in Obstructive Lung Disease SESSION TYPE: Original Investigations PRESENTED ON: 10/11/2023 07:15 am - 08:15 am PURPOSE: Asthma severity and control can vary over time. We sought to understand whether patient characteristics, comorbidities, or environmental factors were associated with reduced asthma severity or improved control over time in the NHLBI Severe Asthma Research Program 3 (SARP3). METHODS: Adult participants with severe asthma and a subset with lack of asthma control at enrollment with at least one follow-up visit were reviewed. Severity was defined by ERS/ATS criteria for severe asthma based on need for high dose inhaled corticosteroids, plus an additional controller or use of a biologic agent for asthma. Asthma was considered uncontrolled if the Asthma Control Test (ACT) was <20. Severity and control were reassessed at the participants’ last visit. We assessed whether baseline pre-bronchodilator spirometry, fractional exhaled nitric oxide (FeNO), eosinophil count, home environment, smoking, or asthma-associated conditions were associated with a re-classification as non-severe or asthma becoming controlled (ACT >20). T-tests were used in R statistical software. RESULTS: In SARP3, 313 adults were classified as having severe asthma at baseline, of whom 227 (74%) had uncontrolled asthma. Average follow-up was 5.4 years ± 1.8 SD. At the last visit, 87 participants (28%) were re-classified as non-severe and 66 (29%) became controlled. Subjects with decreased severity vs persistently severe were more commonly female (76% vs 63% female, p=0.02), had higher baseline FEV1% predicted (72% vs 65% of predicted, p=0.003) and FVC% predicted (84% vs 78% of predicted, p=0.002), had less baseline environmental allergen sensitization (78% vs 89%, p=0.02), and were less likely to have vocal cord dysfunction (VCD) (1.1% vs 8.8%, p<0.001) and nasal polyps (NP) (18% vs 30%, p=0.03). Subjects with improved asthma control vs persistently uncontrolled asthma had lower BMI (32 vs 35 kg/m2, p=0.03), smaller waist circumference (99 vs 107cm, p=0.002), and less reported daily smoke exposure (4.5% vs 16%, p=0.005). Differences in FeNO, eosinophils, and home environment were not significant for either outcome. CONCLUSIONS: During the follow-up period, subjects who had their medications reduced resulting in a reduced asthma severity classification were more likely to be female, have higher baseline lung function, and less likely to have allergen sensitization, VCD, and NP. Those whose asthma control improved had lower BMI and waist circumference, and less current smoke exposure at baseline. CLINICAL IMPLICATIONS: Our data suggest that in patients with severe asthma, women and those with higher lung function are more likely to have their medications reduced, and those with allergen sensitization, NP, and VCD are less likely to have medications reduced. Achieving control was less likely to occur in those with a higher BMI and smoke exposure. DISCLOSURES: No relevant relationships by Jonathan Bailey No relevant relationships by Kathleen Haley No relevant relationships by Olivia Hoyt non-financial support relationship with Vorso Corp Please note: In the past 2 years by Elliot Israel, value=non-financial support Removed 04/04/2023 by Elliot Israel, source=Web Response non-financial support relationship with Circassia Please note: In the past 2 years by Elliot Israel, value=non-financial support Clinical research grants relationship with AstraZeneca Please note: In the past 2 years by Elliot Israel, value=Grant/Research Support Clinical research grants relationship with Avillion Please note: In the past 2 years by Elliot Israel, value=Grant/Research Support Clinical research grants relationship with Gossamer Bio Please note: In the past 2 years by Elliot Israel, value=Grant/Research Support Removed 04/04/2023 by Elliot Israel, source=Web Response Clinical research grants relationship with Novartis Please note: In the past 2 years by Elliot Israel, value=Grant/Research Support Consultant relationship with Arrowhead Pharmaceuticals Please note: 4/13/21 by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Clinical Research grant relationship with Circassia Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=Grant/Research Support non financial support relationship with Genentech Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Sun Pharmaceuticals Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Laurel Pharmaceuticals Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Om Pharmaceuticals Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Nestle Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with CSL Behring Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Glaxo Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support non financial support relationship with Sanofi-Regeneron Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=non financial support Stock owner relationship with Nesos Corp Please note: In past 2 years Added 04/04/2023 by Elliot Israel, source=Web Response, value=Stock Options;unpaid Consultant relationship with Teva Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with AB Science Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Amgen Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with AstraZeneca Please note: In the past 2 years by Elliot Israel, value=Consulting fee Consultant relationship with Avillion Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Biometry Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Cowen Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with GlaxoSmithKline Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Merck Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Novartis Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Pneuma Respiratory Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with PPS Health Please note: In the past 2 years by Elliot Israel, value=Consulting fee Removed 04/04/2023 by Elliot Israel, source=Web Response Consultant relationship with Regeneron Pharmaceuticals Please note: In the past 2 years by Elliot Israel, value=Consulting fee Consultant relationship with Sanofi Genzyme Please note: In the past 2 years Added 04/04/2023 by Elliot Israel, value=Consulting fee non-financial support relationship with Teva Please note: In the past 2 years by Elliot Israel, value=non-financial support No relevant relationships by Carrie Pistenmaa No relevant relationships by Justin Salciccioli