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Multidimensional assessment of severe asthma: A systematic review and meta‐analysis
Author(s) -
Clark Vanessa L.,
Gibson Peter G.,
Genn Grayson,
Hiles Sarah A.,
Pavord Ian D.,
McDonald Vanessa M.
Publication year - 2017
Publication title -
respirology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.857
H-Index - 85
eISSN - 1440-1843
pISSN - 1323-7799
DOI - 10.1111/resp.13134
Subject(s) - medicine , asthma , meta analysis , cohort study , prospective cohort study , airway , exhaled nitric oxide , disease , gerd , systematic review , bronchodilator , physical therapy , medline , spirometry , reflux , surgery , political science , law
The management of severe asthma is complex. Multidimensional assessment ( MDA ) of specific traits has been proposed as an effective strategy to manage severe asthma, although it is supported by few prospective studies. We aimed to systematically review the literature published on MDA in severe asthma, to identify the traits included in MDA and to determine the effect of MDA on asthma‐related outcomes. We identified 26 studies and classified these based on study type (cohort/cross‐sectional studies; experimental/outcome studies; and severe asthma disease registries). Study type determined the comprehensiveness of the assessment. Assessed traits were classified into three domains (airways, co‐morbidities and risk factors). The airway domain had the largest number of traits assessed (mean ± SD = 4.2 ± 1.7) compared with co‐morbidities (3.6 ± 2.2) and risk factors (3.9 ± 2.1). Bronchodilator reversibility and airflow limitation were assessed in 92% of studies, whereas airway inflammation was only assessed in 50%. Commonly assessed co‐morbidities were psychological dysfunction, sinusitis (both 73%) and gastro‐oesophageal reflux disease ( GORD ; 69%). Atopic and smoking statuses were the most commonly assessed risk factors (85% and 86%, respectively). There were six outcome studies, of which five concluded that MDA is effective at improving asthma‐related outcomes. Among these studies, significantly more traits were assessed than treated. MDA studies have assessed a variety of different traits and have shown evidence of improved outcomes. This promising model of care requires more research to inform which traits should be assessed, which traits should be treated and what effect MDA has on patient outcomes.