The Severe Asthma Network in Italy (SANI): findings and perspectives

Publication date: Available online 25 October 2018

Source: The Journal of Allergy and Clinical Immunology: In Practice

Author(s): Enrico Heffler, Francesco Blasi, Manuela Latorre, Francesco Menzella, Pierluigi Paggiaro, Girolamo Pelaia, Gianenrico Senna, Giorgio Walter Canonica, SANI Network

ABSTRACT

Background

Severe Asthma Network in Italy (SANI) is a registry of patients recruited by accredited centers on severe asthma.

Objective

to analyze epidemiological, clinical, inflammatory, functional and treatment characteristics of severe asthmatics from the SANI registry

Methods

All consecutive patients with severe asthma were included into the registry, without exclusion criteria in order to have real-life data on demographics, asthma control, treatments (including biologics), inflammatory biomarkers and comorbidities.

Results

437 patients (mean age: 54.1 years, 57.2% females, 70.7% atopics, 94.5% in GINA severity step 5) were enrolled into the study. Mean annual exacerbation rate was 3.75. Mean blood eosinophil level was 536.7 cells/mcl and average serum total IgE was 470.3 kU/l. About 64% of patients were on regular oral corticosteroid treatment, 57% with omalizumab and 11.2% with mepolizumab. Most common comorbidities were rhinitis, nasal polyposis and bronchiectasis. Patients with nasal polyposis had higher age of disease onset, higher blood eosinophil count and lower frequency of atopy and atopic eczema. Bronchiectasis was associated with more frequent severe exacerbations, higher blood eosinophils and total IgE. Stratifying patients, those with late-onset asthma were less frequently atopic (with less frequent allergic rhinitis and food allergy), and more frequently with nasal polyposis and higher serum total IgE levels.

Conclusions

This study revealed a high frequency of relevant comorbidities and that a substantial proportion of patients have a late-onset asthma; all these features define specific different disease phenotypes. Severe asthma complexity and comorbidities require multidisciplinary approaches, led by specifically trained Pulmonologists and Allergists.