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The Patients’ Experience of Severe Asthma Add-On Pharmacotherapies: A Qualitative Descriptive Study

Authors Clark VL, Gibson PG, McDonald VM

Received 8 December 2020

Accepted for publication 25 January 2021

Published 15 March 2021 Volume 2021:14 Pages 245—258

DOI https://doi.org/10.2147/JAA.S296147

Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 2

Editor who approved publication: Dr Luis Garcia-Marcos


Vanessa L Clark,1,2 Peter G Gibson,1,3 Vanessa M McDonald1– 3

1National Health and Medical Research Council Centre for Research Excellence in Severe Asthma and the Priority Research Centre for Healthy Lungs, The University of Newcastle, New Lambton Heights, NSW, Australia; 2School of Nursing and Midwifery, The University of Newcastle, New Lambton Heights, NSW, Australia; 3Department of Respiratory and Sleep Medicine, John Hunter Hospital, Hunter Medical Research Institute, New Lambton Heights, NSW, Australia

Correspondence: Vanessa M McDonald Email [email protected]

Purpose: Add-on therapies for severe asthma are continually emerging with proven efficacy in randomised controlled trials. To date, however, there are no qualitative studies exploring patients’ experiences with these treatments. We aimed to understand the experience of patients who were treated with an add-on therapy for their severe asthma.
Patients and Methods: A qualitative descriptive study was conducted, participants were recruited from the respiratory clinics and databases of a tertiary referral hospital. Participants with treatment-refractory severe asthma (n=20) prescribed an add-on therapy for > 4 months (75% mepolizumab; 25% omalizumab, and 25% macrolide) were recruited. Qualitative semi-structured interviews were conducted, with interviews thematically analysed.
Results: Participants’ mean (SD) age was 59.5 (15.3) years, and 50% were male. Participants reported 4.5 (2.3) exacerbations in the past year. Asthma Control Questionnaire score was 2.0 (1.4). The monoclonal add-on therapies had been prescribed for a median (IQR) of 12.5 (7.0, 24.0) months. Experience was captured in four emergent themes: “Life is just easier” provided an overall message that the add-on therapy made the participants’ life easier in terms of increasing participation, levelling out symptoms, providing more energy and reducing healthcare use. “Prednisone: A necessary evil” was discussed, particularly in terms of dose and dependence and damaging side effects. The theme “worry and hope for the future” referenced treatment non-response or cessation of effect which was discussed by some participants. Finally, “holistic care” was centred on the sentiment that the participant’s asthma management and overall health were not related to one aspect or medication alone.
Conclusion: Patients with severe asthma experience vast improvements in quality-of-life and life participation with add-on therapies, but there remains a significant burden related to oral corticosteroids and incomplete treatment responses. Addressing this residual burden is an important area for future research.

Keywords: severe asthma, asthma medications, monoclonal antibody therapies, quality of life, patient experience

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