D1.115 - Real World Assessment of Uncontrolled Severe Asthma in Canada - A Multi-Site Qualitative Survey of Type 2 Inflammatory Biomarkers and Clinical Outcomes

Severe asthma represents a healthcare burden with unmet medical needs despite available therapeutic options. This Canadian survey aimed to understand real-world baseline characteristics of uncontrolled severe asthmatic patients and evaluate how type 2 inflammatory biomarkers (eosinophils, IgE, FeNO) assessed during routine care may identify opportunities for quality improvement initiatives.

A qualitative survey was conducted involving chart reviews of 300 uncontrolled severe asthmatic patients from ages 12-80, from seventeen sites across Canada, including both respirologists and allergists from November 2021 to February 2023. Patients were classified as uncontrolled severe asthmatics according to CTS 2017 Canadian Severe Asthma guidelines. Data collected included demographics, biologic usage patterns, type 2 inflammatory biomarker levels, clinical outcomes, and disease burden indicators over the previous 12 months.

Demographics: 56.3% of patients analyzed lived in urban settings.

Biologic Usage: 56% of patients were not receiving biologic therapy; 44% were on biologics (32% anti-IgE, 62% anti-IL-5 class therapy) with 25% using biologics for >4 years.

Type 2 Biomarkers: Elevated type 2 inflammatory markers were prevalent in all: 61.3% had eosinophil levels ≥150 cells/μL, 53% had IgE levels ≥30 IU/mL, 46.7% had FeNO levels ≥25 ppb (18.7% ≥50 ppb). Among anti-IL-5 users, 58% had elevated eosinophils, 56.8% had FeNO levels ≥25 ppb.

Clinical Outcomes: 57.3% had ACQ-5 scores >1, 56.3% experienced ≥1 severe exacerbation, 63.6% required ≥1 oral corticosteroid (OCS) course, 81.5% had ≥1 emergency room visit.

Disease Burden: 49.6% had ≥1 nighttime awakening(s) per week, 28.7% missed workdays (45.3% lost 2-5 days). Comorbid type 2 inflammatory diseases prevalence: chronic rhinosinusitis with nasal polyps (24.3%), food allergies (12.7%), and atopic dermatitis (6.7%).

This real-world survey reveals unmet needs in Canadian severe asthma management. Majority of uncontrolled severe asthmatics (56%) were not receiving biologic therapy, representing treatment gaps. High prevalence of elevated type 2 inflammatory biomarkers across all patients, including those on biologics, suggests opportunities for improved biologic selection and optimization through biomarker-guided therapy. Frequent use of OCS, emergency healthcare utilization, and impact on quality of life underscore the need for enhanced management strategies, better utilization of available biologic therapies to reduce disease burden for Canadian severe asthma patients.