Disease Burden and Treatment Pattern in Chinese Moderate-to-Severe Asthma Patients: Baseline Analysis of a Real-world, Multicentre Study (PRESENT)

Abstract Rationale The diagnosis and management of severe asthma is closely associated with the concept of adequate asthma treatment. In China, it remains unclear whether patients with moderate-to-severe asthma are sufficiently recognized and optimally managed. The PRESENT study is a prospective, observational study aiming to investigate the disease management landscape in patients with moderate-to-severe asthma in China. This baseline analysis focused on current disease burden and treatment patterns of patients upon study enrolment. Methods The PRESENT study (NCT06422663) included 35 hospitals across mainland China, from which patients aged ≥12 years with moderate-to-severe asthma (defined as receiving Step 3-5 treatments according to Global Initiatives for Asthma [GINA] 2023 at baseline) were enrolled. After enrolment, data within the previous 12 months were retrospectively collected. Patients with uncontrolled asthma under medium-to-high dose inhaled corticosteroid (ICS)/long-acting beta2 agonists (LABA) and with controlled asthma under high dose ICS/LABA were categorized as severe asthma, and all others as non-severe asthma. Uncontrolled asthma was defined as Asthma Control Test (ACT) score ≤19 at week 0 or ≥1 asthma exacerbations requiring oral corticosteroids (OCS, continuously use ≥3 days/time) or hospitalization during previous year. Results From March 22 to August 23, 2024, 498 patients were enrolled. Mean (SD) age was 47.2 (15.1) years and 192 (38.6%) patients were male. Family history of respiratory diseases was present in 64 patients, with most (50/64, 78.1%) having a family history of asthma. Asthma-related comorbidities were found in 164 (32.9%) patients, with the most common being chronic rhinitis (135, 27.1%). At enrolment, 175 (35.1%) patients were categorized as having severe asthma. Disease burden in patient subgroups by asthma severity is summarized in Table. Overall, 460 (92.4%) patients were receiving ICS/LABA, 210 (42.2%) were receiving leukotriene receptor antagonists (LTRA), 20 (4.0%) were receiving OCS, and 11 (2.2%) were receiving biologics. Uncontrolled asthma was found in over half of patients receiving medium (154/265, 58.1%) or high (12/21, 57.1%) dose ICS-containing medications. Detailed breakdown of asthma medications is summarized in Table. Conclusions Patients with moderate-to-severe asthma in China face heavy disease burden, including prevalent asthma-related comorbidities, poor symptom control, and high incidence of exacerbations. Although most patients received ICS-containing medications including ICS/LABA as recommended by GINA 2023, symptoms remained uncontrolled in over half of patients receiving medium or high dose ICS-containing medications. In summary, asthma control in patients with moderate-to-severe asthma in China remains unsatisfactory and stepping up treatment may be needed.