ISAR's Session at REG 2021: Summary
A big thank you to everyone who participated in and attended the ISAR session at this year’s REG summit! It was a great success, and the two panel discussions were excellent opportunities to explore different approaches to the common issues we all face in research and clinical practice. The whole session is available on the REG website. A summary of the discussions can be found below:
Panel Discussion: Approaches to identifying hidden severe asthma in COPD
Panelists: Professors Chin Kook Rhee, Leif Bjermer, Arnaud Bourdin, David Price
The problem: Low rates of ex- and current smokers in severe asthma services indicate they are likely hidden under a COPD diagnosis – these patients do not get the opportunity to receive appropriate therapies and tend to have poorer outcomes.
Key challenge: Fixed airway obstruction is seen in both severe asthma and COPD – this overlap of clinical features make distinguishing the two difficult in real life.
“We have to use extremely strict and stringent definitions for asthma and COPD, not only based on pharmaceutical dispensations but also using all the other indicators.” – Prof Bourdin
Potential approaches: identifying features associated with a diagnosis of asthma or COPD:
| Features | Asthma | COPD | Hidden severe asthma in COPD |
| Fixed airway obstruction | Common (++) | Common (+++) | Likely |
| Positive bronchodilator response | Common (+) | Common (+) | Likely |
| Current smoker | Rare | Common (+++) | – |
| Ex-smoker | Common (+) | Common (++) | Likely |
| <10 pack years of smoking history | Common (+) | Rare | Likely |
| Early age of onset (<40 years) | Common (++) | Rare | Likely |
Key COPD subgroups likely to have higher populations of hidden severe asthma patients:
1. Ex-smokers with less than 10 pack years of smoking history.
2. Patients who experienced disease onset before 40 years of age.
Potential databases:
The ISAR database can be used to compare clinical characteristics and response to biologic therapy in ex-smokers vs non-smokers with severe asthma.
The French claims database has previously been used for similar studies, however, it is exhaustive and covers the entire French population of ~70 million people – strict criteria should be used to streamline the process.
Other EMR databases will also likely be useful, however their diagnostic expertise may not be sufficient.
Panel Discussion: Future of registries: Embedding data collection in routine care
Panelists: Professors David Price, John Blakey, Leif Bjermer, Celeste Porsbjerg
The problem: Registry data collection alongside current clinical practice often requires double entry of data.
The goal: To integrate data collection and support for patient management within existing care pathways.
“When you want to implement such systems, it’s really important to think about how your local system works today, but more so how you think it ought to work both from a clinical perspective and a future perspective of how we expect our healthcare systems to evolve.” – Prof Porsbjerg
Real-life success stories:
- The Danish Severe Asthma Registry (DSAR) captures severe asthma patient information in an electronic record form approved for both clinical and research use across the country.
- This is supplemented with information from free text doctor’s notes and integrated questionnaires that patients answer electronically at point of care.
- The Swedish National Airway Register (SwAR) collects medical data and patient-reported information at point of care on the FRISQ platform before it is exported to the registry or EMRs.
- Collected data is accessible by clinicians, enabling them to track their patients’ progress and better understand their disease.
- The Australian difficult to treat asthma audit is a quality improvement programme which will collect and analyze patient data to guide personalized care specific to each individual.
- Bespoke patient questionnaires and pre-filled templates for clinicians supplement data collection and provide a more complete overview of each patient’s condition.
- Clinical recommendations for each patient will be provided, and their disease outcomes will be assessed over time.
Once again, thank you for your participation and attendance at the REG 2021 ISAR Session!