title: Dedicated severe asthma services improve health-care use and quality of life.
abstract: BACKGROUND
  Systematic assessment of severe asthma can be used to confirm the diagnosis, identify comorbidities, and address adherence to therapy. However, the prospective usefulness of this approach is yet to be established. The objective of this study was to determine whether the systematic assessment of severe asthma is associated with improved quality of life (QoL) and health-care use and, using prospective data collection, to compare relevant outcomes in patients referred with severe asthma to specialist centers across the United Kingdom.
  
  
  METHODS
  Data from the National Registry for dedicated UK Difficult Asthma Services were used to compare patient demographics, disease characteristics, and health-care use between initial assessment and a median follow-up of 286 days.
  
  
  RESULTS
  The study population consisted of 346 patients with severe asthma. At follow-up, there were significant reductions in health-care use in terms of primary care or ED visits (66.4% vs 87.8%, P < .0001) and hospital admissions (38% vs 48%, P = .0004). Although no difference was noted in terms of those requiring maintenance oral corticosteroids, there was a reduction in steroid dose (10 mg [8-20 mg] vs 15 mg [10-20 mg], P = .003), and fewer subjects required short-burst steroids (77.4% vs 90.8%, P = .01). Significant improvements were seen in QoL and control using the Asthma Quality of Life Questionnaire and the Asthma Control Questionnaire.
  
  
  CONCLUSIONS
  To our knowledge, this is the first time that a prospective study has shown that a systematic assessment at a dedicated severe asthma center is associated with improved QoL and asthma control and a reduction in health-care use and oral steroid burden.
authors: Royal Brompton Hospital, London, England; Airways Disease, National Heart and Lung Institute, Imperial College, London, England.
authors: David
authors: D
authors: Gibeon
authors: Centre for Infection and Immunity, Queen's University of Belfast, Belfast, Ireland.
authors: Liam G
authors: LG
authors: Heaney
authors: University of Leicester, Leicester, England.
authors: Chris E
authors: CE
authors: Brightling
authors: University of Manchester, Manchester, England; University Hospital of South Manchester, South Manchester, England.
authors: Rob
authors: R
authors: Niven
authors: Birmingham Heartlands Hospital, University of Birmingham, Birmingham, England.
authors: Adel H
authors: AH
authors: Mansur
authors: Gartnavel General Hospital, University of Glasgow, Glasgow, Scotland.
authors: Rekha
authors: R
authors: Chaudhuri
authors: Glasgow Royal Infirmary, Glasgow, Scotland.
authors: Christine E
authors: CE
authors: Bucknall
authors: Royal Brompton Hospital, London, England. Electronic address: A.Menzies-Gow@rbht.nhs.uk.
authors: Andrew N
authors: AN
authors: Menzies-Gow
mesh_terms: D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D019468:Disease Management; D005260:Female; D006760:Hospitalization / Q000639:trends*; D006801:Humans; D008297:Male; D011320:Primary Health Care / Q000592:standards / Q000706:statistics & numerical data*; D011446:Prospective Studies; D058996:Quality Improvement; D011788:Quality of Life; D012189:Retrospective Studies; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D006113:United Kingdom; D055815:Young Adult
chemical_list: D018927:Anti-Asthmatic Agents