Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

ACC 2024 Congress

Catch up on all the top stories and latest evidence in cardiology research with our ACC 2024 Congress hub page.
ADVANCED SEARCH
Log in
Top
Allergy, Asthma & Clinical Immunology
Published in: Allergy, Asthma & Clinical Immunology 1/2018

Open Access 01-12-2018 | Research

Severe, eosinophilic asthma in primary care in Canada: a longitudinal study of the clinical burden and economic impact based on linked electronic medical record data

Authors: Don Husereau, Jason Goodfield, Richard Leigh, Richard Borrelli, Michel Cloutier, Alain Gendron

Published in: Allergy, Asthma & Clinical Immunology | Issue 1/2018

Login to get access

Abstract

Background

Stratification of patients with severe asthma by blood eosinophil counts predicts responders to anti-interleukin (IL)-5 (mepolizumab and reslizumab) and anti-IL-5 receptor α (benralizumab) therapies. This study characterized patients with severe asthma who could qualify for these biologics in a primary care setting.

Methods

We retrospectively selected patients from July 1, 2010, to June 30, 2014, using a linked electronic medical records (EMR) database (IMS Evidence 360 EMR Canada) for > 950,000 patients in primary care in Ontario, Canada. Patients aged ≥ 12 years with ≥ 2 documented asthma diagnoses were identified as having severe asthma based on prescriptions for high-dosage inhaled corticosteroids (ICS) plus either a leukotriene receptor antagonist, long-acting β2-agonist (LABA), or theophylline filled on the same day. Patients’ asthma was considered severe also if they received a prescription for ICS with oral corticosteroids (OCS) or an additional prescription for omalizumab. Patient characteristics, asthma-related medications, and blood eosinophil counts were captured using observed care patterns for the year prior to ICS/LABA and/or OCS prescription. Health care resource use (HCRU) and costs were captured throughout the 1-year follow-up period.

Results

We identified 212 patients who met the criteria for severe asthma. These patients required an average of 6.5 physician visits during the 1-year follow-up period (95% confidence interval 5.7–7.3), and 20 (9%) were referred to respiratory specialists. Overall, 56 patients (26%) with severe asthma had complete blood counts, of whom 23 (41%) had blood eosinophil counts ≥ 300 cells/μL and might be considered for anti-eosinophil therapies. Patients with severe asthma and blood eosinophil counts ≥ 300 cells/μL had more respiratory specialist referrals (17% vs. 12%) than patients with blood eosinophils < 300 cells/μL.

Conclusions

Our data suggest that during 2010–2014, Ontario primary care patients with severe asthma and high blood eosinophil counts had greater HRCU than those with lower counts. Approximately 41% of patients with severe asthma could qualify for anti-eosinophil drugs based on blood eosinophil counts. However, the eosinophilic status of most patients was unknown. It is appropriate to increase awareness of the use of blood eosinophil counts to identify patients who could be considered for anti-eosinophil therapies.
Literature
1.
2.
Lougheed MD, Leniere C, Ducharme FM, Licskai C, Dell SD, Rowe BH, et al. Canadian thoracic society 2012 guideline update: diagnosis and management of asthma in preschoolers, children and adults: executive summary. Can Respir J. 2012;19(6):e81–8.CrossRefPubMedPubMedCentral
3.
4.
Gupta S, Paolucci E, Kaplan A, Boulet LP. Contemporaneous international asthma guidelines present differing recommendations: an analysis. Can Respir J. 2016;2016:3085065.CrossRefPubMedPubMedCentral
5.
Chung KF, Wenzel SE, Brozek JL, Bush A, Castro M, Sterk PJ, et al. International ERS/ATS guidelines on definition, evaluation and treatment of severe asthma. Eur Respir J. 2014;43(2):343–73.CrossRefPubMed
6.
Peters SP, Ferguson G, Deniz Y, Reisner C. Uncontrolled asthma: a review of the prevalence, disease burden and options for treatment. Respir Med. 2006;100(7):1139–51.CrossRefPubMed
7.
8.
Goldman M, Hirsch I, Zangrilli JG, Newbold P, Xu X. The association between blood eosinophil count and benralizumab efficacy for patients with severe, uncontrolled asthma: subanalyses of the Phase III SIROCCO and CALIMA studies. Curr Med Res Opin. 2017;33(9):1605–13.CrossRefPubMed
9.
Ortega HG, Yancey SW, Mayer B, Gunsoy NB, Keene ON, Bleecker ER, et al. Severe eosinophilic asthma treated with mepolizumab stratified by baseline eosinophil thresholds: a secondary analysis of the DREAM and MENSA studies. Lancet Respir Med. 2016;4:549–56.CrossRefPubMed
10.
Corren J, Weinstein S, Janka L, Zangrilli J, Garin M. Phase 3 study of reslizumab in patients with poorly controlled asthma: effects across a broad range of eosinophil counts. Chest. 2016;150(4):799–810.CrossRefPubMed
11.
12.
Busse WW, Ring J, Huss-Marp J, Kahn JE. A review of treatment with mepolizumab, an anti-IL-5 mAb, in hypereosinophilic syndromes and asthma. J Allergy Clin Immunol. 2010;125(4):803–13.CrossRefPubMed
13.
Máspero J. Reslizumab in the treatment of inadequately controlled asthma in adults and adolescents with elevated blood eosinophils: clinical trial evidence and future prospects. Ther Adv Respir Dis. 2017;11(8):311–25.CrossRefPubMed
14.
Kolbeck R, Kozhich A, Koike M, Peng L, Andersson CK, Damschroder MM, et al. MEDI-563, a humanized anti-IL-5 receptor alpha mAb with enhanced antibody-dependent cell-mediated cytotoxicity function. J Allergy Clin Immunol. 2010;125(6):1344–53.CrossRefPubMed
15.
Bleecker ER, FitzGerald JM, Chanez P, Papi A, Weinstein SF, Barker P, et al. Efficacy and safety of benralizumab for patients with severe asthma uncontrolled with high-dosage inhaled corticosteroids and long-acting β2-agonists (SIROCCO): a randomised, multicentre, placebo-controlled phase 3 trial. Lancet. 2016;388(10056):2115–27.CrossRefPubMed
16.
FitzGerald JM, Bleecker ER, Nair P, Korn S, Ohta K, Lommatzsch M, et al. Benralizumab, an anti-interleukin-5 receptor α monoclonal antibody, as add-on treatment for patients with severe, uncontrolled, eosinophilic asthma (CALIMA): a randomised, double-blind, placebo-controlled phase 3 trial. Lancet. 2016;388(10056):2128–41.CrossRefPubMed
17.
Benchimol EI, Smeeth L, Guttmann A, Harron K, Moher D, Petersen I, et al. The reporting of studies conducted using observational routinely-collected health data (RECORD) statement. PLoS Med. 2015;12(10):e1001885.CrossRefPubMedPubMedCentral
18.
Vandenbroucke JP, von Elm E, Altman DG, Gotzsche PC, Mulrow CD, Pocock SJ, et al. Strengthening the reporting of observational studies in epidemiology (STROBE): explanation and elaboration. PLoS Med. 2007;4:e297.CrossRefPubMedPubMedCentral
19.
Frise S, Reidel K, Tarride JE, Corner N, Dziarmaga A. Assessment of a Canadian primary care electronic medical record database for use in observational studies. Value Health. 2013;16:A582.CrossRef
20.
21.
Shojaie S, McCurdy S, Thiele S, Ching Chau L, Martin L, Charland K, et al. Characterization of statin effectiveness using real-world data in a Canadian population. Value Health. 2016;19:A41.CrossRef
22.
Jobin-Gervais K, Zaour N, Caron J, Borrelli R, Fischer AA. A novel method using prescription treatment patterns to estimate heart failure prevalence in Canada. Value Health. 2016;19:A85.CrossRef
23.
Blais L, Lemiere C, Menzies D, Berbiche D. Validity of asthma diagnoses recorded in the medical services database of Quebec. Pharmacoepidemiol Drug Saf. 2006;15(4):245–52.CrossRefPubMed
24.
Gershon AS, Wang C, Guan J, Vasilevska-Ristovska J, Cicutto L, To T. Identifying patients with physician-diagnosed asthma in health administrative databases. Can Respir J. 2009;16(6):183–8.CrossRefPubMedPubMedCentral
25.
26.
Gershon AS, Guan J, Wang C, Victor JC, To T. Describing and quantifying asthma comorbidity [corrected]: a population study. PLoS ONE. 2012;7(5):e34967.CrossRefPubMedPubMedCentral
27.
Mark FitzGerald J, Lemiere C, Lougheed MD, Ducharme FM, Dell DD, Ramsey C, et al. Recognition and management of severe asthma: a Canadian thoracic society position statement. Can J Respir Crit Care Sleep Med. 2007;1(4):199–221.CrossRef
28.
29.
30.
Blais L, Beauchesne M-F, Forget A. Acute care among asthma patients using budesonide/formoterol or fluticasone propionate/salmeterol. Respir Med. 2009;103:237–43.CrossRefPubMed
31.
Anis AH, Lynd LD, Wang XH, King G, Spinelli JJ, Fitzgerald M, et al. Double trouble: impact of inappropriate use of asthma medication on the use of health care resources. CMAJ. 2001;164(4):625–31.PubMedPubMedCentral
32.
Tsilogianni Z, Ntontsi P, Papaioannou AI, Bakakos P, Loukides S. Biomarkers guided treatment strategies in adult patients with asthma: ready for the clinical field? Arch Immunol Ther Exp (Warsz). 2017;65(1):1–9.CrossRef
33.
Wagener AH, de Nijs SB, Lutter R, Sousa AR, Weersink EJ, Bel EH, et al. External validation of blood eosinophils, FE(NO) and serum periostin as surrogates for sputum eosinophils in asthma. Thorax. 2015;70(2):115–20.CrossRefPubMed
34.
Korevaar DA, Westerhof GA, Wang J, Cohen JF, Spijker R, Sterk PJ, et al. Diagnostic accuracy of minimally invasive markers for detection of airway eosinophilia in asthma: a systematic review and meta-analysis. Lancet Resp Med. 2015;3(4):290–300.CrossRef
35.
Bel EH, Wenzel SE, Thompson PJ, Prazma CM, Keene ON, Yancey SW, et al. Oral glucocorticoid-sparing effect of mepolizumab in eosinophilic asthma. N Engl J Med. 2014;371(13):1189–97.CrossRefPubMed
36.
Ortega HG, Liu MC, Pavord ID, Brusselle GG, FitzGerald JM, Chetta A, et al. Mepolizumab treatment in patients with severe eosinophilic asthma. N Engl J Med. 2014;371(13):1198–207.CrossRefPubMed
37.
Nair P, Wenzel S, Rabe KF, Bourdin A, Lugogo NL, Kuna P, et al. Oral glucocorticoid-sparing effect of benralizumab in severe asthma. N Engl J Med. 2017;376(25):2448–58.CrossRefPubMed
38.
Tran TN, Khatry DB, Ke X, Ward CK, Gossage D. High blood eosinophil count is associated with more frequent asthma attacks in asthma patients. Ann Allergy Asthma Immunol. 2014;113(1):19–24.CrossRefPubMed
39.
Schleich FN, Chevremont A, Paulus V, Henket M, Manise M, Seidel L, et al. Importance of concomitant local and systemic eosinophilia in uncontrolled asthma. Eur Respir J. 2014;44:97–108.CrossRefPubMed
40.
Price DB, Rigazio A, Campbell JD, Bleecker ER, Corrigan CJ, Thomas M, et al. Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med. 2015;3(11):849–58.CrossRefPubMed
41.
Zeiger RS, Schatz M, Li Q, Chen W, Khatry DB, Gossage D, et al. High blood eosinophil count is a risk factor for future asthma exacerbations in adult persistent asthma. J Allergy Clin Immunol Pract. 2014;2(6):741–50.CrossRefPubMed
42.
To T, Gershon A, Cicutto L, Wang CN. The burden of asthma: can it be eased? The Ontario record. Healthc Q. 2007;10(1):22–4.CrossRefPubMed
43.
Martin BC, Wiley-Exley EK, Richards S, Domino ME, Carey TS, Sleath BL. Contrasting measures of adherence with simple drug use, medication switching, and therapeutic duplication. Ann Pharmacother. 2009;43(1):36–44.CrossRefPubMed
44.
45.
Hay C, Pacey M, Bains N, Ardal S. Understanding the unattached population in Ontario: evidence from the primary care access survey (PCAS). Healthc Policy. 2010;6(2):33–47.PubMedPubMedCentral
46.
Bateman ED, Boushey HA, Bousquet J, Busse WW, Clark TJ, Pauwels RA, Pedersen SE, GOAL Investigators Group. Can guideline-defined asthma control be achieved? The gaining optimal asthma control study. Am J Respir Crit Care Med. 2004;170(8):836–44.CrossRefPubMed
47.
FitzGerald JM, Boulet LP, McIvor RA, Zimmerman S, Chapman KR. Asthma control in Canada remains suboptimal: the reality of Asthma control (TRAC) study. Can Respir J. 2006;13(5):253–9.CrossRefPubMedPubMedCentral
Metadata
Title
Severe, eosinophilic asthma in primary care in Canada: a longitudinal study of the clinical burden and economic impact based on linked electronic medical record data
Authors
Don Husereau
Jason Goodfield
Richard Leigh
Richard Borrelli
Michel Cloutier
Alain Gendron
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Allergy, Asthma & Clinical Immunology / Issue 1/2018
Electronic ISSN: 1710-1492
DOI
https://doi.org/10.1186/s13223-018-0241-1

Other articles of this Issue 1/2018

Allergy, Asthma & Clinical Immunology 1/2018 Go to the issue

Research

Prevalence of food allergens sensitization and food allergies in a group of allergic Honduran children

Research

Aetiology of anaphylaxis in patients referred to an immunology clinic in Colombo, Sri Lanka

Case report

Sweet syndrome: a rare feature of ANCA-associated vasculitis or unusual consequence of azathioprine-induced treatment

Research

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma

Case report

First reported case in Canada of anaphylaxis to lupine in a child with peanut allergy

Research

Fetal cord blood and tissue immune responses to chronic placental inflammation and chorioamnionitis