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Defining a Severe Asthma Super-Responder: Findings from a Delphi Process

2021; Elsevier BV; Volume: 9; Issue: 11 Linguagem: Inglês

10.1016/j.jaip.2021.06.041

2213-2201

John W. Upham, Chantal Le Lievre, David J. Jackson, Matthew Masoli, Michael E. Wechsler, David Price, Adel Mansur, Aikaterini Detoraki, Alan Altraja, Alan L. James, Alexandra Nanzer-Kelly, Andréanne Côté, Andrew Menzies‐Gow, Andriana Ι. Papaioannou, Anne-Maree Cheffins, Arnaud Bourdin, Bassam Mahboub, Brian J. Lipworth, C.A. Celis-Preciado, Carlos A. Torres‐Duque, Caterina Bucca, Celeste Porsbjerg, Charlotte Suppli Ulrik, Christopher J. Corrigan, Christian Taube, Claude S. Farah, Constance H. Katelaris, David Langton, Dermot Ryan, Désirée Larenas‐Linnemann, Εleftherios Ζervas, Enrico Heffler, Flavia Hoyte, Francesca Puggioni, George Christoff, Giorgio Walter Canonica, Giovanna Elisiana Carpagnano, Giuseppe Guida, Gregory Katsoulotos, Guy Brusselle, Hitashi Rupani, Hubertus Jersmann, I. Clifton, Jaideep Dhariwal, James Fingleton, Jane Duke, Janet Rimmer, John Aubrey Douglass, João Fonseca, Job F. M. van Boven, John Corless, John Harrington, Jorge Máspero, José Luís San Miguel, Kanok Pipatvech, Karrinda Kenny, Kenneth R. Chapman, Κonstantinos Κostikas, Lauri Lehtimäki, Li Ping Chung, Liam G. Heaney, Liang‐Wen Hang, Louis‐Philippe Boulet, Luis Pérez de Llano, L Ricciardi, Majdy Idrees, Manlio Milanese, Maria Elisabetta Conte, Maria Teresa Costantino, Mariko Koh Siyue, Mark Fitzgerald, Mark Hew, Matthew Peters, Ming‐Ju Tsai, Mitesh Patel, Mohammad Hashim Khan, Mohsen Sadatsafavi, Mona Al‐Ahmad, Mona‐Rita Yacoub, Mónica De Gennaro, Naghmeh Radhakrishna, Nicola A. Hanania, Nikolaos G. Papadopoulos, Njira Lugogo, Norma Linaker, Nunzio Crimi, Paddy Dennison, Parameswaran Nair, Patrick Mitchell, Paul M. O’Byrne, Paul Pfeffer, Paula Kauppi, Pauline Hughes, Peter G. Middleton, Peter Wark, Philip G. Bardin, Pin‐Kuei Fu, Praveen Akuthota, Rekha Chaudhuri, R. Diaz Campos, Riyard Al-Lehebi, Roberta Parente, Francisco Rovira, Sally E. Wenzel, Santus Pierachille, Shrikant Pawar, Stelios Loukides, Stephen J. Fowler, Tara Mackenzie, Thomas Brown, Tze Lee Tan, Unnur Steina Björnsdóttir, Vanessa M. McDonald, Veronica Lawriwskyj, Vibeke Backer, Violina Vasileva, Ying‐Chun Chien, Zinta Harrington,

Respiratory and Cough-Related Research

Clinicians are increasingly recognizing severe asthma patients in whom biologics and other add-on therapies lead to dramatic improvement. Currently, there is no agreed-upon super-responder (SR) definition.To survey severe asthma experts using a modified Delphi process, to develop an international consensus-based definition of a severe asthma SR.The Delphi panel was composed of 81 participants (94% specialist pulmonologists or allergists) from 24 countries and consisted of three iterative online voting rounds. Consensus on individual items, whether acceptance or rejection, required at least 70% agreement by panel members.Consensus was achieved that the SR definition should be based on improvement across three or more domains assessed over 12 months. Major SR criteria included exacerbation elimination, a large improvement in asthma control (two or more times the minimal clinically important difference), and cessation of maintenance of oral steroids (or weaning to adrenal insufficiency). Minor SR criteria were composed of a 75% exacerbation reduction, having well-controlled asthma, and 500 mL or greater improvement in FEV1. The SR definition requires improvement in at least two major criteria. In the future, the SR definition should be expanded to incorporate quality of life measures, although current tools can be difficult to implement in a clinical setting and further research is needed.This international consensus-based definition of severe asthma SRs is an important prerequisite for better understanding SR prevalence, predictive factors, and the mechanisms involved. Further research is needed to understand the patient's perspective and to measure quality of life more precisely in SRs.