1. Defining a Severe Asthma Super-Responder: Findings from a Delphi Process
- Author
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Liang-Wen Hang, Karrinda Kenny, Louis-Philippe Boulet, Jane Duke, Désirée Larenas-Linnemann, Claude S. Farah, Mónica De Gennaro, Peter A. B. Wark, Hubertus Jersmann, Maria Teresa Costantino, Dermot Ryan, Mark Hew, Vanessa M. McDonald, Mohammad Hashim Khan, Pin-Kuei Fu, Mitesh Patel, Majdy Idrees, David A. Jackson, Violina Vasileva, Constance H. Katelaris, Matthew Masoli, Nunzio Crimi, Celeste Porsbjerg, Janet Rimmer, Veronica Lawriwskyj, Ying-Chun Chien, Norma Linaker, Sally E. Wenzel, Alan Altraja, Ricardo Campos, Carlos Torres-Duque, Manlio Milanese, Enrico Heffler, Eleftherios Zervas, Andréanne Côté, Guy Brusselle, Alan James, Luis Perez-de-Llano, Jorge Maspero, David Langton, Francesca Puggioni, Mona Al-Ahmad, Riyard Al-Lehebi, Adel H. Mansur, Tom Brown, José Luis Miguel, Chris Corrigan, Arnaud Bourdin, James Fingleton, Brian J. Lipworth, Shrikant Pawar, Paula Kauppi, Philip G. Bardin, Alexandra Nanzer-Kelly, Carlos Andrés Celis-Preciado, Santus Pierachille, David Price, George Christoff, Pauline Hughes, Hitashi Rupani, João Fonseca, Nikolaos G. Papadopoulos, Naghmeh Radhakrishna, Lauri Lehtimäki, Rekha Chaudhuri, Anne-Maree Cheffins, Tara Mackenzie, Christian Taube, Kenneth R. Chapman, Charlotte Suppli Ulrik, Giorgio Walter Canonica, Mariko Koh Siyue, Maria Elisabetta Conte, Giovanna Elisiana Carpagnano, Chantal E. Le Lievre, Mohsen Sadatsafavi, Unnur S. Bjornsdottir, Praveen Akuthota, Mark FitzGerald, Andrew Menzies-Gow, Jaideep Dhariwal, Stelios Loukides, Michael E. Wechsler, Paul E Pfeffer, Matthew J. Peters, Giuseppe Guida, Zinta Harrington, Konstantinos Kostikas, Ian Clifton, Tze Lee Tan, Andriana I. Papaioannou, Li Ping Chung, John W. Upham, Parameswaran Nair, John Harrington, Aikaterini Detoraki, Liam G Heaney, Roberta Parente, Paul M. O'Byrne, Jo A Douglass, Kanok Pipatvech, Ming-Ju Tsai, Caterina Bucca, Vibeke Backer, Peter Middleton, Patrick Mitchell, Paddy Dennison, Luisa Ricciardi, Njira L Lugogo, Job F M van Boven, Flavia C.L. Hoyte, Stephen J. Fowler, Gregory Katsoulotos, Bassam Mahboub, Rovira Francisco, Nicola A. Hanania, John Corless, Mona-Rita Yacoub, Physiologie & médecine expérimentale du Cœur et des Muscles [U 1046] (PhyMedExp), Université de Montpellier (UM)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), and Centre Hospitalier Régional Universitaire [Montpellier] (CHRU Montpellier)
- Subjects
medicine.medical_specialty ,Exacerbation ,[SDV]Life Sciences [q-bio] ,Delphi method ,Biologics ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Quality of life ,Randomized controlled trial ,law ,medicine ,Immunology and Allergy ,Asthma ,Asthma treatment ,Consensus ,Delphi Technique ,Humans ,Surveys and Questionnaires ,Quality of Life ,030212 general & internal medicine ,Intensive care medicine ,ComputingMilieux_MISCELLANEOUS ,business.industry ,Minimal clinically important difference ,medicine.disease ,3. Good health ,030228 respiratory system ,Asthma Control Questionnaire ,Allergists ,business - Abstract
Background Clinicians are increasingly recognizing severe asthma patients in whom biologics and other add-on therapies lead to dramatic improvement. Currently, there is no agreed-upon super-responder (SR) definition. Objective To survey severe asthma experts using a modified Delphi process, to develop an international consensus-based definition of a severe asthma SR. Methods The Delphi panel was composed of 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of three iterative online voting rounds. Consensus on individual items, whether acceptance or rejection, required at least 70% agreement by panel members. Results Consensus was achieved that the SR definition should be based on improvement across three or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (two or more times the minimal clinically important difference), and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria were composed of a 75% exacerbation reduction, having well-controlled asthma, and 500 mL or greater improvement in FEV1. The SR definition requires improvement in at least two major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, although current tools can be difficult to implement in a clinical setting and further research is needed. Conclusions This international consensus-based definition of severe asthma SRs is an important prerequisite for better understanding SR prevalence, predictive factors, and the mechanisms involved. Further research is needed to understand the patient's perspective and to measure quality of life more precisely in SRs.
- Published
- 2021
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