Abstract
Background: Clinicians are increasingly recognising severe asthma patients in whom biologicals and other add-on therapies lead to dramatic improvement. Currently, there is no agreed upon super72 responder (SR) definition.
Objective: To survey severe asthma experts using a modified Delphi process in order to develop an international consensus-based definition of a severe asthma ‘super-responder’.
Methods: The Delphi panel comprised 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of 3 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 or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (≥ 2x the minimal clinically important difference) and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria comprised a 75% exacerbation reduction, having well controlled asthma and a 500mL or greater
83 improvement in FEV1. The SR definition requires improvement in at least 2 major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, though 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 super responders is an important prerequisite for better understanding super-responder prevalence, predictive factors and the mechanisms involved. Further research is needed to understand the patient perspective and measure quality of life more precisely in super-responders.
Objective: To survey severe asthma experts using a modified Delphi process in order to develop an international consensus-based definition of a severe asthma ‘super-responder’.
Methods: The Delphi panel comprised 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of 3 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 or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (≥ 2x the minimal clinically important difference) and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria comprised a 75% exacerbation reduction, having well controlled asthma and a 500mL or greater
83 improvement in FEV1. The SR definition requires improvement in at least 2 major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, though 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 super responders is an important prerequisite for better understanding super-responder prevalence, predictive factors and the mechanisms involved. Further research is needed to understand the patient perspective and measure quality of life more precisely in super-responders.
| Original language | English |
|---|---|
| Pages (from-to) | 3997-4004 |
| Number of pages | 8 |
| Journal | The Journal of Allergy and Clinical Immunology: In Practice |
| Volume | 9 |
| Issue number | 11 |
| Early online date | 13 Jul 2021 |
| DOIs | |
| Publication status | Published - 5 Nov 2021 |
Bibliographical note
Funding Information:This project was supported by in kind contributions from the Observational and Pragmatic Research Institute and the University of Queensland Faculty of Medicine. No pharmaceutical companies were involved in the study design or execution.
Keywords
- Asthma
- Biologics
- Asthma treatment