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Predominance of Atopic Asthma in Patients with Severe or Difficult-to-Treat Asthma in the Tenor II Cohort
Monday, March 7, 2016
South Exhibit Hall H (Convention Center)
Larry Borish, MD FAAAAI, Stanley J. Szefler, MD FAAAAI, Robert S. Zeiger, MD PhD FAAAAI, Aimee Foreman, MA, Steve Greenberg, MD, Tmirah Haselkorn, Farid Kianifard, PhD, Meryl Mendelson, MD, Brandee Paknis, PharmD, Scott T. Weiss , MD MS, Bradley E. Chipps, MD FAAAAI

Rationale: The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens evaluated patients with severe or difficult-to-treat asthma (TENOR I). TENOR II assessed long-term outcomes in this cohort.  

Methods: TENOR II (n=341) was a prospective, multicenter observational study with a single follow-up assessment in 2014, more than a decade after TENOR I. Atopic asthma was defined as having ≥1 positive specific-IgE test (≥0.35kU/L). Clinical measures of atopic and non-atopic asthma patients were examined, as well as very poorly controlled (VPC) asthma based on National Heart, Lung, and Blood Institute asthma guidelines.

Results: Of 317 patients with a specific IgE measure, the majority (n=231; 72.9%) had atopic asthma; 86 (27.1%) had non-atopic asthma.  IgE geometric mean was 130.7 IU/mL and 14.1 IU/mL for atopic and non-atopic cohorts, respectively. The most common positive IgE tests for atopic patients were perennial aero-allergens: cat dander (59.7%), dog dander (53.7%) and Dermatophagoides farinadust mite (43.7%). Mean (SD) blood eosinophil count for atopic and non-atopic groups were 201/µL (143) and 198/µL (147), respectively.  Atopic and non-atopic patients were as likely to report any asthma exacerbation (defined as hospitalization/ER visit for exacerbations requiring corticosteroids) in the prior three months [24.7% (57/231) and 26.7% (23/86), respectively]. Over half (52.0%; 115/221) of atopic patients had persistent VPC asthma (VPC at TENOR I and TENOR II) versus 45.8% (38/83) of non-atopic patients.

Conclusions: Atopic asthma was highly prevalent and more frequent than non-atopic asthma in TENOR II; however frequency of exacerbations and level of control were generally similar between the two subgroups.