Medical Unmet Needs in Uncontrolled Asthma Despite GINA Step 4/5 Treatment in Poland

Background: Asthma is a heterogeneous chronic respiratory disease characterized by symptoms such as wheezing, shortness of breath, cough, and bronchial obstruction confirmed in spirometry. According to the Polish National Health Fund (NHF), in 2023 there were 2.07 million patients with asthma (International Classification of Diseases, ICD-10 codes J45, J46) in Poland. Despite guideline-based treatment recommended by the Global Initiative for Asthma (GINA) at steps 4 and 5, a substantial proportion of patients remain uncontrolled, leading to significant clinical and societal burden. Objective: This study aimed to identify the prevalence of uncontrolled asthma among adults receiving GINA step 4/5 therapy in Poland and to characterise the most common medical unmet needs (MUNs). Methods: We analyzed prescription data from the IQVIA™ Longitudinal Prescription Data (LRx) database covering approximately 55% of Polish pharmacies between November 2023 and October 2024. Adult patients (≥ 20 years) with GINA step 4/5 asthma were identified based on treatment patterns, including inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), long-acting muscarinic antagonists (LAMA), oral corticosteroids (OCS), and biologics. MUNs were defined as: (1) annual OCS exposure > 500 mg, (2) ≥ 2 exacerbations requiring high-dose OCS rescue medication, and (3) excessive short-acting beta-agonist (SABA) use (> 3 packs/year). Results: Among 1.44 million adult asthma patients, 372,905 (26%) were classified as GINA step 4/5. Of these, 64,235 (17.2%) exhibited at least one MUN. High OCS exposure was most frequent (54% of MUN patients), followed by ≥ 2 exacerbations (38%) and SABA overuse (45%). Conclusion: Despite advanced therapy, a significant proportion of GINA step 4/5 asthma patients in Poland remain uncontrolled. Addressing these unmet needs requires optimized treatment strategies, improved patient education, and broader access to biologic therapies.