D1.150 - Patient characteristics and treatment patterns in adults with severe asthma in Poland (POLSAR): a retrospective, single-center real-world cohort from ISAR

Severe asthma is heterogeneous and burdensome, and country-level, real-world characterization can guide phenotyping and treatment selection. We aimed to describe demographics, clinical status, biomarkers, comorbidities, and therapies among adults with severe asthma in Poland.

Historical cohort using anonymised ISAR registry data (enrolment between Aug 2013–Dec 2024). Adults at GINA Step 5 were analysed - on high-dose ICS plus another controller. Baseline was the 12-month period before biologic initiation (for patients initiating biologics) or ISAR enrolment. Data were analysed descriptively.

504 patients analysed; 63.2% female, mean age 54 years (77.3% <65), mean asthma onset age 35 years, mean duration 19.4 years with 70.2% ≥10 years. Elevated BMI common (overweight 31.9%, obese 30.5%). In biologic initiators, prior 12 months showed substantial exacerbation burden (mean 3.1, 31.5% ≥4; hospitalisation/emergency mean 0.8, median 0). Poor asthma control: 97.2% GINA uncontrolled (n=72), mean ACQ 2.71 (n=139) with 82.7% ≥1.5. Impaired lung function: mean FEV1% predicted 65.8% (n=193), 39.9% <60%; FEV1/FVC <0.7 in 51.1% (n=325). Type 2-high features predominated: eosinophilic gradient likely (4.8%) and most likely (68.6%); blood eosinophils ≥350 cells/μL 64.0% (n=283); total IgE ≥75 kU/L 74.3% (n=191); combined elevation (BEC ≥150 and IgE ≥75) 61.0% (n=136). Seasonal allergy frequent (76.7%, n=202). Among biologic-treated patients, biomarkers remained elevated regardless of OCS (no OCS: IgE ≥75 67.8%, BEC ≥300 64.1%; OCS: IgE ≥75 71.9%, BEC ≥150 84.4%). High comorbidity burden (81.5% ≥1; 46.1% ≥3): chronic rhinosinusitis 47.9%, nasal polyposis 25.6%, allergic rhinitis 42.7%, cardiovascular disease 52.2%. Most received ICS+LABA (91.9%), 26.4% LAMA; maintenance OCS use high (42.7%). Biologic therapy initiated in 96.4%: anti-IgE 33.0%, anti-IL-5 28.8%, anti-IL5R 26.0%, anti-IL-4/IL-13 4.8%, anti-TSLP 3.8%.

This national severe asthma cohort exhibited long-standing disease, poor control, impaired lung function, high exacerbation and OCS burden, predominant eosinophilic-allergic/type 2-high features with substantial comorbidities.