Rationale Knowledge about the clinical importance of patient-reported outcome measures
(PROMs) in severe asthma is limited. Objectives To assess whether and to what extent
asthma exacerbations affect changes in PROMS over time and asthma-specific PROMs can
predict exacerbations in adult patients with severe asthma in usual care. Methods
Data of 421 patients with severe asthma (62% female; mean age 51.9 +/- 13.4 years;
mean FEV1 67.5 +/- 21.3%pred) from the U-BIOPRED cohort were analyzed. The included
PROMs were: Asthma Control Questionnaire (ACQ5); Asthma Quality of Life Questionnaire
(AQLQ); Hospital Anxiety and Depression scale (HADS); Epworth Sleepiness Scale (ESS);
Medication Adherence Report Scale (MARS); Sino-Nasal Outcomes Test (SNOT20). Participants
were assessed at baseline and after 12-18 months of usual care. Results PROMs showed
very weak to weak correlations with clinical characteristics such as age, body mass
index, FEV1, FeNO and eosinophilic cell count. Patients presenting no exacerbations
during follow-up showed a statistically significant improvement in all PROMs (except
for MARS), whereas individuals experiencing > 2 exacerbations showed a deterioration.
Baseline ACQ5 was a predictor of exacerbations with an AUC of 0.590 (95%CI 0.514-0.666).
Conclusions The association of PROMs with clinical measures was poor in severe asthmatics.
Moreover, PROMs were prone to changes in usual care, with exacerbations playing a
key role. PROMs need to be systematically evaluated in severe asthma to improve clinical
care based on specific patient's needs.
