Introduction: Evidence on the prevalence of uncontrolled asthma upon the standard of care in Japan is scarce and inconsistent. We report the prevalence of uncontrolled asthma using the Japanese Guidelines for Asthma (JGL) 2018 and Global Initiative for Asthma (GINA) 2019 classifications in patients who are currently receiving standard-of-care treatment in a real-life setting. Methods: In this prospective, 12-week, noninterventional study, patients with asthma aged 20–75 years and continuously treated with medium- or high-dose inhaled corticosteroid (ICS)/LABA, with or without other controller(s), were assessed for their asthma control status. The demographics, clinical characteristics, treatment patterns, health care resource utilization, patient-reported outcomes (PROs), and adherence to prescribed treatments were assessed for patients classified as either controlled or uncontrolled. Results: Of 454 patients, 53.7% and 36.3% of the patients reported their asthma as uncontrolled based on the JGL and GINA criteria, respectively. Uncontrolled asthma was even higher (JGL, 75.0%; GINA, 63.5%) within the subpopulation of 52 patients receiving long-acting muscarinic antagonists (LAMAs; i.e., ICS/LABA/LAMA subpopulation). Sensitivity analysis by propensity matching identified significant odds ratios of controlled versus uncontrolled asthma for several demographics and clinical characteristics: male; sensitization to animals, fungi, or birch; comorbidities including food allergy or diabetes; and history of exacerbation were associated with the risk of uncontrolled asthma. No significant changes in PROs were observed. Conclusion: The frequency of uncontrolled asthma in the study population was high, as per JGL and GINA guidelines, despite good adherence to ICS/LABA treatment and other prescribed treatments over 12 weeks.

Keywords:
Asthma, Demographics, Clinical characteristics, Guideline-based therapy, Prevalence
1.
Inoue H, Kozawa M, Milligan KL, Funakubo M, Igarashi A, Loefroth E. A retrospective cohort study evaluating healthcare resource utilization in patients with asthma in Japan. NPJ Prim Care Respir Med. 2019;29(1):13.
2.
Nakamura Y, Tamaoki J, Nagase H, Yamaguchi M, Horiguchi T, Hozawa S, et al. Japanese guidelines for adult asthma 2020. Allergol Int. 2020;69(4):519–48.
3.
Global Initiative for Asthma. Global strategy for asthma management and prevention. https://org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms. pdf.
4.
Czira A, Turner M, Martin A, Hinds D, Birch H, Gardiner F, et al. A systematic literature review of burden of illness in adults with uncontrolled moderate/severe asthma. Respir Med. 2022;191:106670.
5.
Inoue H, Milligan KL, McConnon A, Yoshisue H, Loefroth E, McSharry M, et al. Uncontrolled asthma: a retrospective cohort study in Japanese patients newly prescribed with medium-/high-dose ICS/LABA. NPJ Prim Care Respir Med. 2021;31(1):12.
6.
Nagase H, Adachi M, Matsunaga K, Yoshida A, Okoba T, Hayashi N, et al. Prevalence, disease burden, and treatment reality of patients with severe, uncontrolled asthma in Japan. Allergol Int. 2020;69(1):53–60.
7.
Adachi M, Hozawa S, Nishikawa M, Yoshida A, Jinnai T, Tamura G. Asthma control and quality of life in a real-life setting: a cross-sectional study of adult asthma patients in Japan (ACQUIRE-2). J Asthma. 2019;56(9):1016–25.
8.
Buhl R, Heaney LG, Loefroth E, Larbig M, Kostikas K, Conti V, et al. One-year follow up of asthmatic patients newly initiated on treatment with medium-or high-dose inhaled corticosteroid-long-acting β2-agonist in UK primary care settings. Respir Med. 2020;162:105859.
9.
Lötvall J, Bleecker ER, Busse WW, O’Byrne PM, Woodcock A, Kerwin EM, et al. Efficacy and safety of fluticasone furoate 100 μg once-daily in patients with persistent asthma: a 24-week placebo and active-controlled randomised trial. Respir Med. 2014;108(1):41–9.
10.
Busse WW, Bleecker ER, Bateman ED, Lötvall J, Forth R, Davis AM, et al. Fluticasone furoate demonstrates efficacy in patients with asthma symptomatic on medium doses of inhaled corticosteroid therapy: an 8-week, randomised, placebo-controlled trial. Thorax. 2012;67(1):35–41.
11.
UMIN-CTR. 2020. Available from: https://center6.umin.ac.jp/cgi-open- bin/ctr/ctr.cgi?function=brows&action=brows&recptno=R000003580&type=summary&language=J.
12.
Salciccioli JD, She L, Tulchinsky A, Rockhold F, Cardet JC, Israel E. Effect of COVID-19 on asthma exacerbation. J Allergy Clin Immunol Pract. 2021;9(7):2896–9.e1.
13.
Geraldini M, Chong Neto HJ, Riedi CA, Rosário NA. Epidemiology of ocular allergy and co-morbidities in adolescents. J Pediatr (Rio J). 2013;89(4):354–60.
14.
Sozener ZC, Ozturk BO, Cerci P, Turk M, Akin BG, Akdis M, et al. Epithelial barrier hypothesis: effect of external exposome on microbiome and epithelial barriers in allergic disease. Allergy. 2022;77(5):1418–49.
15.
Kerstjens HAM, Maspero J, Chapman KR, van Zyl-Smit RN, Hosoe M, Tanase AM, et al. Once-daily, single-inhaler mometasone-indacaterol-glycopyrronium versus mometasone-indacaterol or twice-daily fluticasone-salmeterol in patients with inadequately controlled asthma (IRIDIUM): a randomised, double-blind, controlled phase 3 study. Lancet Respir Med. 2020;8(10):1000–12.
16.
Denning DW, O’Driscoll BR, Hogaboam CM, Bowyer P, Niven RM. The link between fungi and severe asthma: a summary of the evidence. Eur Respir J. 2006;27(3):615–26.
17.
Denning DW, Pashley C, Hartl D, Wardlaw A, Godet C, Del Giacco S, et al. Fungal allergy in asthma-state of the art and research needs. Clin Transl Allergy. 2014;4:14.
18.
Bjerg A, Winberg A, Berthold M, Mattsson L, Borres MP, Rönmark E. A population-based study of animal component sensitization, asthma, and rhinitis in schoolchildren. Pediatr Allergy Immunol. 2015;26(6):557–63.
19.
Gergen PJ, Mitchell HE, Calatroni A, Sever ML, Cohn RD, Salo PM, et al. Sensitization and exposure to pets: the effect on asthma morbidity in the US population. J Allergy Clin Immunol Pract. 2018;6(1):101–7.e2.
20.
Nwaru BI, Suzuki S, Ekerljung L, Sjölander S, Mincheva R, Rönmark EP, et al. Furry animal allergen component sensitization and clinical outcomes in adult asthma and rhinitis. J Allergy Clin Immunol Pract. 2019;7(4):1230–8.e4.
21.
Kleine-Tebbe J, Mailänder C. Patterns of allergen sensitization in patients with severe asthma in Germany. J Allergy Clin Immunol Pract. 2020;8(2):744–6.e3.
22.
Berns SH, Halm EA, Sampson HA, Sicherer SH, Busse PJ, Wisnivesky JP. Food allergy as a risk factor for asthma morbidity in adults. J Asthma. 2007;44(5):377–81.
23.
Sullivan PW, Ghushchyan VH, Globe G, Schatz M. Oral corticosteroid exposure and adverse effects in asthmatic patients. J Allergy Clin Immunol. 2018;141(1):110–6.e7.
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