Perception phenotypes in difficult-to-treat asthma based on asthma control reported by patients and lung function

BACKGROUND: Self-reported asthma control and lung function are key to evaluating asthma status, but they are not always concordant in patients with difficult-to-treat (difficult) asthma, indicating potential heterogeneity in patients' asthma perception. OBJECTIVE: This study aimed to classify asthma perception phenotypes using both asthma control reported by patients and lung function, and to examine their associations with clinical characteristics in difficult asthma. METHODS: 185 patients with difficult asthma who attended secondary care asthma clinics were classified into four asthma perception phenotypes based on Asthma Control Questionnaire scores (6-item) (impaired cut-off: ≥ 1.5) and post-bronchodilator forced expiratory volume in one second expressed as percentage of predicted values (impaired cut-off: < 80% predicted), measured via spirometry. Bivariate analyses and multinomial logistic regression analyses were performed to examine the associations of asthma perception phenotypes with clinical characteristics. RESULTS: Only about 55% of patients showed concordant perceived asthma control and lung function. Regardless of their lung function, patients with perceived poorer asthma control reported lower quality of life, more depressive symptoms, and more oral corticosteroid courses. The most-impaired asthma perception phenotype (characterised by both impaired perceived asthma control and lung function) was associated with male sex, low medication adherence, and comorbidity diagnoses of chronic obstructive pulmonary disease (COPD), obesity, and depression. CONCLUSION: We identified concordant and discordant asthma perception phenotypes in difficult asthma and highlighted their clinical relevance. A holistic approach to identifying and addressing low medication adherence, comorbid COPD, obesity, and depression may provide key targets in clinical practice to improve difficult asthma outcomes, such as asthma control, lung function, and psychosocial functioning.