Characterization of Severe Asthma Worldwide: Data From the International Severe Asthma Registry

Chest. 2020 Apr;157(4):790-804. doi: 10.1016/j.chest.2019.10.053. Epub 2019 Nov 27.


Background: Clinical characteristics of the international population with severe asthma are unknown. Intercountry comparisons are hindered by variable data collection within regional and national severe asthma registries. We aimed to describe demographic and clinical characteristics of patients treated in severe asthma services in the United States, Europe, and the Asia-Pacific region.

Methods: The International Severe Asthma Registry retrospectively and prospectively collected data in patients with severe asthma (≥ 18 years old), receiving Global Initiative for Asthma (GINA) Step 5 treatment or with severe asthma remaining uncontrolled at GINA Step 4. Baseline demographic and clinical data were collected from the United States, United Kingdom, South Korea, Italy, and the Severe Asthma Web-based Database registry (including Australia, Singapore, and New Zealand) from December 2014 to December 2017.

Results: We included 4,990 patients. Mean (SD) age was 55.0 (15.9) years, and mean (SD) age at asthma onset was 30.7 (17.7) years. Patients were predominantly female (59.3%) and white (72.6%), had never smoked (60.5%), and were overweight or obese (70.4%); 34.9% were at GINA Step 5; and 57.2% had poorly controlled disease. A total of 51.1% of patients were receiving regular intermittent oral corticosteroids, and 25.4% were receiving biologics (72.6% for those at GINA Step 5). Mean (SD) exacerbation rate was 1.7 (2.7) per year. Intercountry variation was observed in clinical characteristics, prescribed treatments, and biomarker profiles.

Conclusions: Using a common data set and definitions, this study describes severe asthma characteristics of a large patient cohort included in multiple severe asthma registries and identifies country differences. Whether these are related to underlying epidemiological factors, environmental factors, phenotypes, asthma management systems, treatment access, and/or cultural factors requires further study.

Keywords: Feno; IgE; biologics; comorbidity; eosinophils.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Asthma* / diagnosis
  • Asthma* / epidemiology
  • Asthma* / physiopathology
  • Asthma* / therapy
  • Comorbidity
  • Disease Progression
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • International Cooperation
  • Male
  • Medication Therapy Management / statistics & numerical data
  • Middle Aged
  • Needs Assessment
  • Obesity / epidemiology*
  • Registries / statistics & numerical data
  • Severity of Illness Index
  • White People / statistics & numerical data


  • Glucocorticoids