Gaps in Care Among Uncontrolled Severe Asthma Patients in the United States

Background Understanding the implementation of key guideline recommendations is critical for management of severe asthma (SA) in the treatment of uncontrolled disease. Objective To assess specialist visits and medication escalation in US patients with SA following events indicating-uncontrolled-disease (EUD) and associations with health outcomes and social disparity indicators. Methods SA patients appearing in administrative claims data spanning 2015-2020 were indexed hierarchically on asthma-related EUD, including hospitalizations, emergency department visits with systemic corticosteroid treatment (SCS), or outpatient visits with SCS. SA patients without EUD served as controls. Eligibility included age 12+, 12-months enrollment pre- and post-index, no biologic use, and no other major respiratory disease during the pre-period. Escalation of care in the form of specialist visits and medication escalation, healthcare resource utilization (HCRU), costs, and disease exacerbations were assessed during follow-up. Results 180,736 SA patients were identified (90,368 uncontrolled, 90,368 controls). Between 35-51% of SA patients with an EUD had no specialist visit or medication escalation. Follow-up exacerbations ranged from 51-64% across EUD cohorts, compared to 13% in controls. Among uncontrolled SA patients who were Black or Hispanic/Latino, 41% and 38%, respectively, had no specialist visit or medication escalation after EUD, compared to 33% of non-Hispanic White patients. Conclusion A substantial proportion of uncontrolled SA patients had no evidence of specialist visits or medication escalation following uncontrolled disease, and there was a clear relationship between uncontrolled disease and subsequent HCRU and exacerbations. Findings highlight the need for improved guideline-based care delivery to SA patients, particularly for those facing social disparities.