The impact of sex on severe asthma: a cross-sectional retrospective analysis of UK primary and specialist care:a cross-sectional retrospective analysis of UK primary and specialist care

After puberty, females are more likely to develop asthma and in a more severe form than males. The associations between asthma and sex are complex with multiple intrinsic and external factors. To evaluate the sex differences in the characteristics and treatment of patients with severe asthma (SA) in a real-world setting. Demographic, clinical and treatment characteristics for patients with SA in the UK Severe Asthma Registry (UKSAR) and Optimum Patient Care Research Database (OPCRD) were retrospectively analysed by sex using univariable and multivariable logistic regression analyses adjusted for year, age and hospital/practice. 3679 (60.9% female) patients from UKSAR and 18 369 patients (67.9% female) from OPCRD with SA were included. Females were more likely to be symptomatic with increased Asthma Control Questionnaire-6 (UKSAR adjusted OR (aOR) 1.14, 95% CI 1.09 to 1.18) and Royal College of Physicians-3 Question scores (OPCRD aOR 1.29, 95% CI 1.13 to 1.47). However, they had a higher forced expiratory volume in 1 second per cent (FEV %) predicted (UKSAR 68.7% vs 64.8%,

Characterising the impact of sex on severe asthma (SA) in the UK Severe Asthma Registry (UKSAR)

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Temperature-controlled laminar airflow in severe asthma for exacerbation reduction (The LASER Trial):study protocol for a randomised controlled trial

Background: Asthma affects more than 5 million patients in the United Kingdom. Nearly 500,000 of these patients have severe asthma with severe symptoms and frequent exacerbations that are inadequately controlled with available treatments. The burden of severe asthma on the NHS is enormous, accounting for 80 % of the total asthma cost (£1 billion), with frequent exacerbations and expensive medications generating much of this cost.Of those patients with severe asthma, 70 % are sensitised to indoor aeroallergens, and the level of exposure to allergens determines the symptoms; patients exposed to high levels are therefore most at risk of exacerbations and hospital admissions.The LASER trial aims to assess whether a new treatment, temperature controlled laminar airflow (TLA) delivered by the Airsonett™ device, can reduce the frequency of exacerbations in patients with severe allergic asthma by reducing exposure to aeroallergens overnight.Methods: This multicentre study is a placebo-controlled, blinded, randomised controlled, parallel group trial. A total of 222 patients with a new or current diagnosis of severe allergic asthma will be assigned with a random element in a 1:1 ratio to receive either an active device for one year or a placebo device. The primary outcome is the frequency of severe asthma exacerbations occurring over a 12-month period, defined in accordance with the American Thoracic Society/European Respiratory Society (ATS/ERS) guidelines. Secondary outcomes include changes in asthma control, lung function, asthma-specific and global quality of life for participants and their carers, adherence to intervention, healthcare resource use and costs, and cost-effectiveness. Qualitative interviews will be conducted to elicit participant’s and their partner’s perceptions of the treatment.Discussion: Effective measures of allergen avoidance have, to date, proved elusive. The LASER trial aims to address this. The study will ascertain whether home-based nocturnal TLA usage over a 12-month period can reduce the frequency of exacerbations and improve asthma control and quality of life as compared to placebo, whilst being cost-effective and acceptable to adults with poorly controlled, severe allergic asthma. The results of this study will be widely applicable to the many patients with allergic asthma both in the UK and internationally.Trial registration: Current controlled trials ISRCTN46346208 (Date assigned 22 January 2014).<br/

Exhaled volatile organic compounds in adult asthma: a systematic review

The search for biomarkers that can guide precision medicine in asthma, particularly those that can be translated to the clinic, has seen recent interest in exhaled volatile organic compounds (VOCs). Given the number of studies reporting "breathomics" findings and its growing integration in clinical trials, we performed a systematic review of the literature to summarise current evidence and understanding of breathomics technology in asthma.A PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses)-oriented systematic search was performed (CRD42017084145) of MEDLINE, Embase and the Cochrane databases to search for any reports that assessed exhaled VOCs in adult asthma patients, using the following terms (asthma AND (volatile organic compounds AND exhaled) OR breathomics).Two authors independently determined the eligibility of 2957 unique records, of which 66 underwent full-text review. Data extraction and risk of bias assessment was performed on the 22 studies deemed to fulfil the search criteria. The studies are described in terms of methodology and the evidence narratively summarised under the following clinical headings: diagnostics, phenotyping, treatment stratification, treatment monitoring and exacerbation prediction/assessment.Our review found that most studies were designed to assess diagnostic potential rather than focus on underlying biology or treatable traits. Results are generally limited by a lack of methodological standardisation and external validation and by insufficiently powered studies, but there is consistency across the literature that exhaled VOCs are sensitive to underlying inflammation. Modern studies are applying robust breath analysis workflows to large multi-centre study designs, which should unlock the full potential of measurement of exhaled volatile organic compounds in airways diseases such as asthma.</p

Impact of the Wessex AsThma CoHort (WATCH) study on recruitment to research

WATCH is a longitudinal observational study of patients under the Difficult Asthma Clinic at University Hospital Southampton (UHS), UK. Enhanced asthma phenotyping in the study helps improve patient care, as well as identifying patients suitable for research. These patients may otherwise be missed due to divide between clinical and research goals.One objective was to measure the impact of large outpatient cohort recruitment on patient enrolment rates in asthma research.Method: Adult Severe asthmatics (British Thoracic Society (BTS) step 4 or 5) were recruited from the Difficult Asthma clinic at UHS. Monthly recruitment numbers are shown for adult severe asthmatics PreWATCH (Jun 2014-Dec 2014) and PostWATCH (Jun 2015-Dec 2015).Figure1Download figure | Open in new tab | Download powerpointResults: Total number of patients recruited PreWATCH was 21. Total number of patients recruited in PostWATCH group was 201. This includes patients recruited to WATCH itself (n=161) but also those recruited to non-WATCH adult severe asthma studies (n=40). Percentage improvement in recruitment PostWATCH was 47.5%. Overall improvement in recruitment (including WATCH) was 111.67%.Conclusion: Preliminary analysis suggests improvement to overall recruitment following commencement of WATCH. Further planned analysis will include qualitative questionnaires, and will hopefully show both positive impact on recruitment rates, as well as improvements to patient care and clinic/research experience.<br/

The Wessex AsThma CoHort (WATCH) difficult asthma study: integrating research into the clinic

The WATCH Study is a longitudinal study of patients under the Difficult Asthma Clinic at University Hospital Southampton, UK. To create a better real life understanding of difficult asthma (British Thoracic Society (BTS) step 4/5), a process of clinical dataset compilation, meeting clinical and research needs, was adopted.One objective was to trial feasibility of longitudinal data collection in a large outpatient clinic cohort. Other aims included;a) Merging research and clinical objectives; meeting needs of the BTS Difficult Asthma registry plus data collation needed for research purposesb) Ensuring all eligible patients have the opportunity to participate in research, current and future.c) Gathering all relevant clinical data to support clinical phenotypingd) Ensuring data was collected in a time efficient mannerFigure1Download figure | Open in new tab | Download powerpointNumber of patients recruited to date (175). Recruitment rate (18.2 per month). Total recruitment failures; due to lack of asthma severity (10). Number declining participation (8). Number withdrawn (1) (no reason given).Using a method combining clinical and research services to collect longitudinal data from this large cohort of patients attending the Difficult Asthma clinic was feasible and successful. The majority of patients approached were consented, participated and stayed in the study.<br/

Asthma did not increase in-hospital Covid-19 related mortality in a tertiary UK hospital

Asthma is the most prevalent chronic inflammatory respiratory disease worldwide affecting one in twelve adults (8.3%) in the United Kingdom (UK) (1). Coronavirus disease 2019 (Covid-19) has afflicted at least 80.3 million patients worldwide (17.3 million in the EU, 2.3 million in the UK), and has resulted in more than 1.6 million deaths (427,000 in the EU, 71,000 in the UK) (European Centre for Disease Prevention and Control: 30/12/2020). It is still unclear how asthma affects Covid-19 related mortality with marked regional differences noted (2).</p

Does early-onset difficult asthma in adulthood differ by sex? Findings from WATCH.

Background: Whether the nature of early-onset difficult adult asthma differs by sex remains unclear. Aim: To assess clinical characteristics of early-onset difficult asthma in adulthood stratified by sex. Method: The Wessex AsThma CoHort of difficult asthma (WATCH) at University Hospital Southampton (UHS) UK has enrolled 380 patients from the UHS tertiary difficult asthma clinics. We compared clinical characteristics between sexes in patients with early-onset difficult asthma (age of diagnosis ≤18 years). Results: 190 patients had early-onset difficult asthma; 72.1% female (F) and 27.9% male (M). Median age of diagnosis (F vs M) was 5.0 yrs v 3.0 yrs (p=0.033) with a disease duration of 30.0 yrs v 41.5 yrs (p=0.047). Significant differences in comorbidities (F vs M) existed for salicylate sensitivity (29.9% v 8.0% p=0.002), depression (49.6% v 23.8% p=0.004) and bronchiectasis (7.4% v 21.6% p=0.006). No significant differences were seen for atopy, rhinitis, GORD, obesity, other functional comorbidities (dysfunctional breathing, vocal cord dysfunction and anxiety) or healthcare utilisation. F had a higher prevalence for maintenance oral steroids use (41.6% v 24.5% p=0.029). M showed significantly greater airflow obstruction (M vs F); FEV1 67.9% pred. v 81.7%, FEV1/FVC 62.1% pred. v 71.8% and FEF25-75 35.9% pred. v 56.8% (p&lt;0.001), and higher smoking prevalence (52.8% v 36.5% p=0.040). Conclusion: Early-onset difficult asthma in adulthood was predominantly female, but showed different features by sex. Females had higher prevalence of depression, salicylate sensitivity and steroid dependency, while males were diagnosed earlier, had higher smoking prevalence, worse lung function and associated bronchiectasis

Asthma control is associated with smoking status: Findings from WATCH

Background: Difficult asthmatics with a history of smoking, experience increased lung reactivity. Associations between related comorbidities need further investigation.Aim: To evaluate the symptoms of difficult asthmatics in relation to smoking status, in the Wessex AsThma Cohort of difficult asthma (WATCH) Southampton, UK.Methods: The smoking status of 377 adult asthmatics in WATCH was assessed for asthma control, symptoms of hyperventilation and depression. A retrospective analysis compared smoking status of difficult asthmatics using Chi square (categorical data) and Kruskall-Wallis (continuous data).Results: 180 (48%) had a history of smoking, of whom 13 continued to smoke. Differences in smoking status were not associated with BMI, but did differ by sex, age and age at diagnosis. Asthma control and symptoms of hyperventilation in ex-smokers was comparable to that of never smokers. Current smoking was associated with increased symptoms of depression and decreased attentional control than ever smokers.Conclusion: Prevalence of smoking in difficult asthma is low, but is associated with lack of asthma and attentional control, hyperventilation and depression. These findings highlight the benefits of smoking cessation.<br/