Defining future risk in asthma Pt. II John Blakey Senior Clinical Lecturer, LSTM

Measure first – provide tailored solution

Figure reproduced with permission from Green et al Figure reproduced with permission from Green et al. Lancet 2002;360:1715-21.

Figure produced by Blakey JD Figure produced by Blakey JD. A representation of a potential coordinates system to inform asthma management. Ongoing poor daily control results in escalation along the y axis and ongoing risk of severe asthma attack leads to escalation along the x axis. Letters represent example patients.

Pauwels RA et al. N Engl J Med 1997;337:1405-1411.

Omalizumab for treating severe persistent allergic asthma: NICE technology appraisal guidance (2013) National Institute for Health and Care Excellence (2013). Omalizumab for treating severe persistent allergic asthma. NICE technology appraisal guidance (TA278).

Risk assessment tools

Asthma UK. Asthma attack risk checker. Available from https://www Asthma UK. Asthma attack risk checker. Available from https://www.asthma.org.uk/advice/manage-your-asthma/risk/checker/ [Accessed Dec 2016].

Identifying risk of future asthma attacks using UK medical record data: a respiratory effectiveness group initiative Blakey JD et al. J Allergy Clin Immunol Pract 2016. doi: 10.1016/j.jaip.2016.11.007. The Respiratory Effectiveness Group (REG). Future Asthma Risk (FAR) Calculator. Available from http://effectivenessevaluation.org/ARC/ [Accessed Dec 2016].

JSB3 cardiovascular risk calculator Joint British Societies for the prevention of cardiovascular disease. JBS3 Risk Calculator. Available from http://www.jbs3risk.com [Accessed Dec 2016].

Joint British Societies for the prevention of cardiovascular disease Joint British Societies for the prevention of cardiovascular disease. JBS3 Risk Calculator. Available from http://www.jbs3risk.com [Accessed Dec 2016].

Common knowledge

“30% risk of snow” Communicating risk

Figure reproduced with permission from Blakey J et al Figure reproduced with permission from Blakey J et al. Prim Care Respir J 2013; 22(3): 344-352.

e.g. weight loss e.g. new drug Porter ME. N Engl J Med 2010; 363(26): 2477-2481. Figure produced by Blakey JD.

β2−agonist use before hospital attendance Figure reproduced from Patel M et al. NPJ Prim Care Respir Med 2015;25:14099, licensed under CC BY-NC-ND 4.0.

Reduce magnitude of loss

Intervene early >20% less likely to get OCS Get them days later in the episode 2-3 x more likely to come back to the ED More likely to report ongoing problems 2 week later Both pregnant and non-pregnant women have 65% concordance with OCS bursts Cydulka RK et al. Am J Respir Crit Care Med 1999;160: 887–92; McCallister JW et al. Respir Med. 2011;105(10):1434-40.

National Center for Biotechnology Information (NCBI). https://www.ncbi.nlm.nih.gov/pubmed

Summary New approaches are needed to activate people with asthma and guide therapeutic choices Opportunities exist through newer technologies There are significant gaps in evidence around routine practice