Document resource
Context: the challenge of unresolved breathlessness in asthmaBreathlessness is the predominant symptom driving the asthma pathway. In primary care, people with asthma who remain breathless despite treatment escalation are typically referred to secondary care. Notably, Type 2 (T2)-high patients may remain breathless even when biologic therapy successfully controls inflammatory biomarkers. In the Type-2 biomarker versus symptom-based treatment trial (Lancet Respir Med 2021; 9:57–61), a substantial number of patients with well-controlled biomarkers were reluctant to reduce treatment, highlighting the disconnect between biomarker control and symptom burden.Methods We analysed data from 1628 patients who attended the Severe Asthma Service in autumn 2024. Information from each patient’s earliest contact with the service was extracted to reflect asthma status at the time of referral, while the most recent available data were used to assess the impact of tertiary care treatment (HRA IRAS 342426). Breathlessness was evaluated using the Asthma Control Questionnaire (ACQ), comparing scores at entry with the latest score available to understand the impact of treatment. An ACQ of ≤0.75 typically indicates good asthma control, while ACQ of ≥1.5 is indicative of poor asthma control.Results The latest overall ACQ median (IQR) of 2.2 (1.2–3.2) demonstrated a statistically significant change compared to ACQ at service entry 2.4 (1.4–3.3). Patients started on biologics also demonstrated a statistically significant change in ACQ: 2.7 (1.7–3.5) vs 2.3 (1.2 -3.3). In both cases, the difference did not meet the ACQ minimally clinically important difference (MCID) of 0.5. In 561 patients in which the highest ever eosinophil was <0.3, median ACQ remained unchanged at 2.3 at both entry and follow-up.Abstract M25 Table 1 All(n=1628) On biologics(n=448) Eosinophil <0.3(n=561) Eosinophil >0.3(n=619) Age in years, median (IQR)54.9 (41.3–65.0)56.4 (46.5–64.9)54.5 (39.0–64.4)54.1 (39.0–65.6)Males, n, %510 (31.3)106 (37.3)132 (22.2)212 (32.0)BMI in kg/m2, median (IQR)30.9 (26.4–36.7)31.2 (27.1–37.2)31.4 (26.7–37.6)30.3 (25.9–36.3)Baseline FeNO, median (IQR)20.0 (11.0–43.0)26.5 (15.0–56.0)15.0 (8.0–24.0)23.0 (12.0–48.0)Latest FeNO, median (IQR)21.0 (12.0–42.8)31.0 (17.0–55.0)15.0 (9.0–26.0)24.0 (13.0–44.0)Baseline ACQ, median (IQR)2.4 (1.4–3.3)*2.7 (1.7–3.5)*2.3 (1.4–3.5)2.1 (1.0–3.0)Latest ACQ, median (IQR)2.2 (1.2–3.2)*2.3 (1.2–3.3)*2.3 (1.3–3.3)2.0 (1.2–3.0)*Within–group comparisons of ACQ scores showed statistically significant differences for the overall cohort and for those on biologics (Wilcoxon signed–rank test, adjusted with Bonferroni correction)Discussion Comprehensive data from a single centre demonstrate a post treatment median ACQ of 2.2 which is well above the cut-off for poor control. Though there was a statistically significant fall in ACQ with treatment in patients started on biologics, this did not meet the ACQ MCID, and the ACQ of 2.3 was also above the ACQ cut-off for good control of 0.75. These data support the Lind Alliance Breathlessness consensus that interventions to address non-T2 high breathlessness in severe asthma clinics is a research priority.