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 Number withdrawn (1) (no reason given).Using a method combining clinical and research services to collect longitudinal data from this large cohort of patients attending the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/

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/

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

Symptomatic GORD in difficult asthma is associated with worse asthma control and related comorbidities: Findings from WATCH

Background: Difficult asthma is associated with increased prevalence of gastro-oesophageal reflux disease (GORD). However, it is unclear how controlling comorbid GORD impacts difficult asthma.Aim: To evaluate the impact of effectively controlling GORD symptoms in difficult asthmatics in the Wessex AsThma Cohort of difficult asthma (WATCH) Southampton UK.Methods: A retrospective analysis was undertaken to compare the reported symptoms of GORD in 311 adult asthmatics on treatment for GORD. We compared patients with ongoing GORD symptoms against those with no symptoms using Chi square (categorical data) and Mann-Whitney U tests (continuous data).Results: 208 (67%) difficult asthmatics had GORD, of whom 175 were receiving treatment for GORD. Prevalence of symptomatic GORD in those having treatment did not differ by sex, but was associated with higher BMI, worse asthma control and symptoms of depression, rhinitis and cough.Conclusion: Inadequately controlled GORD in difficult asthma is associated with increased symptoms of asthma, and related comorbidities. This highlights multiple potential benefits of optimising GORD treatment in difficult asthmatics

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/

Does the nature of adult difficult asthma differ by age of onset? Findings from WATCH

Background: Phenotypic differences between early-onset (EODA) and adult-onset (AODA) difficult asthma in adulthood are not well described. Aim: To characterise EODA and AODA in difficult asthma. Methods: The Wessex AsThma CoHort of difficult asthma (WATCH) is a longitudinal study at University Hospital Southampton (UHS) UK set up in 2015. To date, 380 patients are enrolled from the UHS tertiary difficult asthma clinic. Clinical features of EODA (age ≤18 yrs) and AODA (age &gt;18 yrs) are presented here. Results: Of 368 patients with available data, 51.6% had EODA and 48.4% AODA (median age of onset 4.0 yrs v 40.5 yrs respectively (

Clinical characteristics of the Wessex AsThma CoHort of difficult asthma (WATCH)

Background: The Wessex AsThma CoHort of difficult asthma (WATCH) is a large prospective observational cohort study established at University Hospital Southampton (UHS) UK in 2015. Patients are enrolled from the UHS tertiary difficult asthma clinic. Aim: WATCH aims to improve understanding of the nature of difficult asthma in clinical practice. Here we report enrolment clinical characteristics. Methods: Patients undergo extensive clinical characterisation and phenotyping at enrolment using collated historical data plus objective clinical measurements. 380 patients have been enrolled to date with annual follow-up thereafter. Results: (as below) Conclusion: The cohort predominantly consists of female, middle-aged, atopic and obese patients whose disease often began before adulthood. The cohort showed high prevalence for maintenance oral steroids and omalizumab. WATCH provides a well-characterised cohort of patients to facilitate real-life difficult asthma research

New Perspectives on Difficult Asthma; Sex and Age of Asthma-Onset Based Phenotypes

International audienceBackground: Asthma is a diverse condition that differs with age and sex. However, it remains unclear how sex, age of asthma-onset, and/or their interaction, influence clinical expression of more problematic adult “difficult” asthma.Objectives: To better understand the clinical features of difficult asthma within a real-world clinical setting using novel phenotypic classification, stratifying subjects by sex and age of asthma-onset.Methods: Participants in a longitudinal difficult asthma clinical cohort study (Wessex AsThma CoHort of difficult asthma; WATCH), United Kingdom, (n=501) were stratified into 4 difficult asthma phenotypes based on sex and age of asthma-onset (early<18-years or adult≥18-years) and characterised in relation to clinical and pathophysiological features.Results: The cohort had more female participants (65%) but had similar proportions of participants with early or adult-onset disease. Early-onset female disease was commonest (35%), highly atopic, with good spirometry and strong associations to some physical comorbidities but highest psychophysiologic comorbidities. Adult-onset females also had considerable psychophysiologic comorbidities, highest obesity, and were least atopic. Amongst male subjects, proportionately more had adult-onset disease. Early-onset male disease was rarest (14%) but associated with worst lung function, high smoking, atopy and fungal sensitisation. Despite shortest disease duration, adult-onset males had highest use of maintenance oral corticosteroid, poor lung function and highest FeNO in spite of highest smoking prevalence.Conclusion: This study shows that sex, age of asthma-onset, and their interactions influence different clinical manifestations of difficult asthma and identifies a greater risk for lung function loss and oral corticosteroid dependency associated with smoking in adult-onset male subject

Protocol for the Wessex AsThma CoHort of difficult asthma (WATCH): a pragmatic real-life longitudinal study of difficult asthma in the clinic

Background: Asthma is now widely recognised to be a heterogeneous disease. The last two decades have seen the identification of a number of biological targets and development of various novel therapies. Despite this, asthma still represents a significant health and economic burden worldwide. Why some individuals should continue to suffer remains unclear. Methods: The Wessex Asthma Cohort of Difficult Asthma (WATCH) is an ongoing 'real-life', prospective study of patients in the University Hospital Southampton Foundation Trust (UHSFT) Difficult Asthma service. Research data capture is aligned with the extensive clinical characterisation required of a commissioned National Health Service (NHS) Specialist Centre for Severe Asthma. Data acquisition includes detailed clinical, health and disease-related questionnaires, anthropometry, allergy and lung function testing, radiological imaging (in a small subset) and collection of biological samples (blood, urine and sputum). Prospective data are captured in parallel to clinical follow up appointments, with data entered into a bespoke database. Discussion: The pragmatic ongoing nature of the WATCH study allows comprehensive assessment of the real world clinical spectrum seen in a Specialist Asthma Centre and allows a longitudinal perspective of deeply phenotyped patients. It is anticipated that the WATCH cohort would act as a vehicle for potential collaborative asthma studies and will build upon our understanding of mechanisms underlying difficult asthma.</p