Gaps in Care Among Uncontrolled Severe Asthma Patients in the United States.

BACKGROUND: Understanding the implementation of key guideline recommendations is critical for management of severe asthma (SA) in the treatment of uncontrolled disease.

OBJECTIVE: To assess specialist visits and medication escalation in US patients with SA following events indicating-uncontrolled-disease (EUD) and associations with health outcomes and social disparity indicators.

METHODS: SA patients appearing in administrative claims data spanning 2015-2020 were indexed hierarchically on asthma-related EUD, including hospitalizations, emergency department visits with systemic corticosteroid treatment (SCS), or outpatient visits with SCS. SA patients without EUD served as controls. Eligibility included age 12+, 12-months enrollment pre- and post-index, no biologic use, and no other major respiratory disease during the pre-period. Escalation of care in the form of specialist visits and medication escalation, healthcare resource utilization (HCRU), costs, and disease exacerbations were assessed during follow-up.

RESULTS: 180,736 SA patients were identified (90,368 uncontrolled, 90,368 controls). Between 35-51% of SA patients with an EUD had no specialist visit or medication escalation. Follow-up exacerbations ranged from 51-64% across EUD cohorts, compared to 13% in controls. Among uncontrolled SA patients who were Black or Hispanic/Latino, 41% and 38%, respectively, had no specialist visit or medication escalation after EUD, compared to 33% of non-Hispanic White patients.

CONCLUSION: A substantial proportion of uncontrolled SA patients had no evidence of specialist visits or medication escalation following uncontrolled disease, and there was a clear relationship between uncontrolled disease and subsequent HCRU and exacerbations. Findings highlight the need for improved guideline-based care delivery to SA patients, particularly for those facing social disparities.