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Defining a Severe Asthma Super-Responder: Findings from a Delphi Process
John W Upham1, Chantal Le Lievre2, David J Jackson3
1Diamantina Institute, University of Queensland, Brisbane, Queensland, Australia; Department of Respiratory Medicine, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
Summary
A consensus definition for severe asthma super-responders (SRs) was developed. The definition requires significant improvement in at least two major criteria across three domains over 12 months.
Area of Science:
- Pulmonology
- Allergology
- Clinical Medicine
Background:
- Clinicians identify severe asthma patients with significant improvement from biologics and add-on therapies.
- A standardized definition for severe asthma super-responders (SRs) is currently lacking.
Purpose of the Study:
- To establish an international consensus-based definition for severe asthma SRs.
- To survey severe asthma experts using a modified Delphi process.
Main Methods:
- An international panel of 81 experts (pulmonologists/allergists) from 24 countries participated.
- Three iterative online voting rounds were conducted, requiring at least 70% agreement for consensus.
Main Results:
- Consensus was reached on an SR definition based on improvement in three or more domains over 12 months.
- Major criteria include exacerbation elimination, substantial asthma control improvement, and oral steroid cessation.
- Minor criteria involve exacerbation reduction, well-controlled asthma, and FEV1 improvement; at least two major criteria are required.
Conclusions:
- The established definition is crucial for understanding SR prevalence, predictors, and mechanisms.
- Future research should incorporate quality of life measures and patient perspectives for a more comprehensive SR definition.
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