D1.114 - The Hidden Costs of Severe Asthma Treatment: Unveiling the Iatrogenic Burden

Asthma is a prevalent chronic respiratory disease, with severe asthma representing a challenging subset. Despite optimal treatment adherence and addressing contributory factors, many patients require intensive therapies that often cause considerable adverse events (AEs), worsening the disease burden. Data on the frequency and profile of these AEs remain scarce. This study aims to characterize the iatrogenic burden in patients with severe asthma.

Observational, cross-sectional study including severe asthma patients (children and adults) followed at the Allergy and Clinical Immunology department of a tertiary hospital. Data were collected using a standardized questionnaire during the first consultation and complemented by clinical records. Informed consent was provided by all participants. Sociodemographic data, aeroallergen sensitization, body mass index (BMI), asthma therapy, Asthma Control Test (ACT) and medication-related AEs were analyzed.

Among the 48 patients, 32 (66.7%) were female. The median age was 23.50 years (range 7–71) and the median BMI was 23.24 (IQR 10.56). Aeroallergen sensitization was observed in 41 patients (87.2%). Based on ACT and c-ACT scores asthma was poorly controlled in 35 participants (72.9%). Regarding therapy, 68.8% of patients were on high dose inhaled corticosteroids and long-acting beta-agonists, 54.1% on long-acting muscarinic antagonist, 16.7% on systemic corticosteroids (SCS), and 79.2% on anti-leukotrienes. Furthermore, 53.5% underwent two or more short-term SCS cycles in the past year. Medication-related AEs were reported by 79.2% of patients, with palpitations (44.4%; 95%CI: 28–57%), suspected adrenal suppression (38.6%; 95%CI: 22–51%), xerostomia (38.6%; 95%CI: 22–51%), headaches (35.6%; 95%CI: 20-48%), dysphonia (22.7%; 95%CI: 10-35%), tremors (17.8%; 95%CI: 7.5-30%), and osteoporosis (9.8%; 95%CI: 2-20%) being the most common.

This study highlights the substantial iatrogenic burden faced by patients with severe asthma. Despite adherence to guideline-recommended treatments a significant proportion experienced poor asthma control, leading to frequent use of SCS. The high prevalence of medication-related AEs underscores the urgent need for strategies to mitigate treatment-related harms. Our findings underscore the importance of personalized treatment plans, regular monitoring and management of medication-related AEs.