학술논문
Severe asthma: One disease and multiple definitions
Document Type
article
Author
Diego Bagnasco, MD, PhD; Pierluigi Paggiaro, MD; Manuela Latorre, MD; Chiara Folli, BS; Elisa Testino, MD; Arianna Bassi, MD; Manlio Milanese, MD; Enrico Heffler, MD; Andrea Manfredi; Anna Maria Riccio, BS; Laura De Ferrari, BS; Francesco Blasi; Rikki Frank Canevari, MD; Giorgio Walter Canonica, MD; Giovanni Passalacqua, MD; Gabriella Guarnieri; Vincenzo Patella; Foschino Barbaro Maria Pia; Giovanna Elisiana Carpagnano; Anna del Colle; Giulia Scioscia; Pelaia Gerolamo; Francesca Puggioni; Francesca Racca; Elisabetta Favero; Sandra Iannacone; Eleonora Savi; Marcello Montagni; Gianna Camiciottoli; Chiara Allegrini; Carlo Lombardi; Giuseppe Spadaro; Caterina Detoraki; Francesco Menzella; Carla Galeone; Patrizia Ruggiero; Monna Rita Yacoub; Alvise Berti; Nicola Scichilone; Carmen Durante; Maria Teresa Costantino; Chiara Roncallo; Mariachiara Braschi; Alice D’Adda; Erminia Ridolo; Massimo Triggiani; Roberta Parente; D’Amato Maria; Maria Vittoria Verrillo; Giovanni Rolla; Luisa Brussino; Agata Valentina Frazzetto; Zappa Maria Cristina; Marianna Lilli; Nunzio Crimi; Marco Bonavia; Angelo Guido Corsico; Amelia Grosso; Stefano Del Giacco; Margherita Deidda; Luisa Ricciardi; Stefania Isola; Francesca Cicero; Giuliana Amato; Federica Vita; Antonio Spanevello; Patrizia Pignatti; Francesca Cherubino; Dina Visca; Fabio Luigi Massimo Ricciardolo; Vitina Maria Anna Carriero; Francesca Bertolini; Pierachille Santus; Roberta Barlassina; Andrea Airoldi; Giuseppe Guida; Nucera Eleonora; Arianna Aruanno; Angela Rizzi; Cristiano Caruso; Stefania Colantuono; Gianenrico Senna; Marco Caminati; Alessandra Arcolaci; Andrea Vianello; Fulvia Chieco Bianchi; Maria Rita Marchi; Stefano Centanni; Simone Luraschi; Silvia Ruggeri; Rocco Rinaldo; Elena Parazzini; Cecilia Calabrese; Martina Flora; Lorenzo Cosmi; Linda Di Pietro; Enrico Maggi; Laura Pini; Luigi Macchia; Danilo Di Bona; Luca Richeldi; Carola Condoluci; Leonello Fuso; Matteo Bonini; Alessandro Farsi; Giulia Carli; Paolo Montuschi; Giuseppe Santini; Maria Elisabetta Conte; Elisa Turchet; Carlo Barbetta; Francesco Mazza; Simona D’Alo; Stefano Pucci; Maria Filomena Caiaffa; Elena Minenna; Luciana D'Elia; Carlo Pasculli; Vittorio Viviano; Paolo Tarsia; Joyce Rolo; Mariacarmela Di Proietto; Salvatore Lo Cicero
Source
World Allergy Organization Journal, Vol 14, Iss 11, Pp 100606- (2021)
Subject
Language
English
ISSN
1939-4551
Abstract
Introduction: There is, so far, no universal definition of severe asthma. This definition usually relies on: number of exacerbations, inhaled therapy, need for oral corticosteroids, and respiratory function. The use of such parameters varies in the different definitions used. Thus, according to the parameters chosen, each patient may result in having severe asthma or not. The aim of this study was to evaluate how the choice of a specific definition of severe asthma can change the allocation of patients. Methods: Data collected from the Severe Asthma Network Italy (SANI) registry were analyzed. All the patients included were then reclassified according to the definitions of U-BIOPRED, NICE, WHO, ATS/ERS, GINA, ENFUMOSA, and TENOR. Results: 540 patients, were extracted from the SANI database. We observed that 462 (86%) met the ATS/ERS criteria as well as the GINA criteria, 259 (48%) the U-Biopred, 222 (41%) the NICE, 125 (23%) the WHO, 313 (58%) the Enfumosa, and 251 (46%) the TENOR criteria. The mean eosinophil value were similar in the ATS/ERS, U-Biopred, and Enfumosa (528, 532 and 516 cells/mcl), higher in WHO and Tenor (567 and 570 cells/mcl) and much higher in the NICE classification (624 cells/mcl). Lung function tests resulted similarly in all groups, with WHO (67%) and ATS/ERS-GINA (73%), respectively, showing the lower and upper mean FEV1 values. Conclusions: The present observations clearly evidence the heterogeneity in the distribution of patients when different definitions of severe asthma are used. However, the recent definition of severe asthma, provided by the GINA document, is similar to that indicated in 2014 by ATS/ERS, allowing mirror reclassification of the patients examined. This lack of homogeneity could complicate the access to biological therapies. The definition provided by the GINA document, which reflects what suggested by ATS/ERS, could partially overcome the problem.