Perception Phenotypes in Difficult-to-Treat Asthma Based on Asthma Control Reported by Patients and Lung Function

Self-reported asthma control and lung function are key to evaluating asthma status, but they are not always concordant in patients with difficult-to-treat (difficult) asthma, indicating potential heterogeneity in patients' asthma perception.

To classify asthma perception phenotypes using both asthma control reported by patients and lung function, and to examine their associations with clinical characteristics in difficult asthma.

We classified 185 patients with difficult asthma who attended secondary care asthma clinics into four asthma perception phenotypes based on Asthma Control Questionnaire scores (six-item) (impaired cutoff of ≥1.5) and postbronchodilator FEV₁ expressed as a percentage of predicted values (impaired cutoff of <80% predicted), measured via spirometry. We performed bivariate analyses and multinomial logistic regression analyses to examine the associations of asthma perception phenotypes with clinical characteristics.

Only about 55% of patients showed concordant perceived asthma control and lung function. Regardless of lung function, patients with perceived poorer asthma control reported lower quality of life, more depressive symptoms, and more OCS courses. The most-impaired asthma perception phenotype (characterized by both impaired perceived asthma control and lung function) was associated with male sex, low medication adherence, and comorbidity diagnoses of chronic obstructive pulmonary disease, obesity, and depression.

We identified concordant and discordant asthma perception phenotypes in difficult asthma and highlighted their clinical relevance. A holistic approach to identifying and addressing low medication adherence, comorbid chronic obstructive pulmonary disease, obesity, and depression may provide key targets in clinical practice to improve difficult asthma outcomes, such as asthma control, lung function, and psychosocial functioning.