{
  "abstract": "Introduction Anxiety and obesity are associated with adverse asthma outcomes. We aim to describe their impact on symptom burden in newly diagnosed and misdiagnosed asthma patients.Method We used data collected from two independent cohorts. Whilst symptomatic, untreated individuals with GP-suspected asthma were recruited into the RADicA study (Manchester, UK), the SMART study (Dublin, Ireland) included patients with a diagnostic label of asthma who have persistent symptoms despite inhaled corticosteroids (ICS), both undergoing diagnostic evaluation using objective testing. Symptom burden was assessed using the Asthma Control Questionnaire (ACQ) and Asthma Control Test (ACT). Asthma diagnosis was determined by clinical history, objective assessments (blood eosinophil count [BEC], fractional exhaled nitric oxide [FeNO], bronchodilator reversibility and bronchial challenge testing) and treatment response. All participants underwent anthropometric measurements and provided self-reported history of anxiety.Results Of 137 symptomatic adults (>16 yrs, 60.6% female) recruited to the RADicA study, 59% had asthma. Anxiety and/or obesity (A/O) were more prevalent in symptomatic non-asthmatic group (60%) compared to asthmatic group (47%). Asthmatic individuals with A/O had higher symptom burden both pre- and post-ICS, independent of FeNO, BEC or lung function ( table 1), and were less likely to achieve well-controlled symptoms post-ICS (OR [95% CI]: 0.28 [0.22–0.84], p = 0.021). In SMART study, of 113 individuals with a diagnostic label of asthma who remained symptomatic despite ICS, 44% did not have asthma. The prevalence of A/O was higher in symptomatic patients without asthma (60%) compared to asthmatic group (55%). Although ACT scores did not differ between asthmatic individuals with and without A/O (table), those with co-existing obesity self-rated their asthma control worse (p = 0.034). Symptoms became controlled in those without asthma after addressing treatable traits and ICS cessation/reduction (baseline ACT: 18[14–23] and post-ICS reduction: 21[15–24]).Abstract M23 Table 1Impact of obesity and anxiety on symptom burden and object disease markers in adult patients with confirmed asthma in RADicA and SMART studies RADicA (n=77) SMART (n=63) No obesity and/or anxiety n=40 Presence of obesity or/and Anxiety n=37 p-value No obesity and/or anxiety n=30 Presence of obesity or/and Anxiety n=33 p-value Baseline (pre-ICS) Baseline (at recruitment, on ICS) ACQ-5, points 0.8 (0.4–1.6) 1.6 (1–2.6) 0.003 ACT scores 17 (12–21) 16 (13–18) 0.53 BEC, x109 cells/L 0.3 (0.16–0.7) 0.26 (0.16, 0.41) 0.333 0.33 (0.19–0.49) 0.25 (0.16–0.35) 0.25 FeNO, ppb 49.5 (23.8–92.2) 48 (15–91) 0.564 33 (22–50) 24 (16–0) 0.13 FEV1% predicted,% 94 (84.5–103) 90 (81.5–97.5) 0.209 85 (65–111) 77 (65–119) 0.80 Post ICS (Flixotide 200 mcg twice daily) Post ICS Relvar (92 or 184 mcg daily) ACQ-5, points 0.2 (0–0.8) 0.7 (0.2–1.2) 0.020 ACT score 21 (15–23) 19 (14–21) 0.25 BEC, x109 cells/L 0.31 (0.14, 0.42) 0.24 (0.14, 0.3) 0.467 0.29 (0.23–0.50) 0.23 (0.15–0.44) 0.19 FeNO, ppb 21 (17–32) 18 (10–31) 0.233 22 (17–30) 21 (14–27) 0.41 FEV1% predicted,% 96 (86–106) 95 (87–101) 0.653 85 (72–94) 80 (66–96) 0.73 All results presented as Median (IQR ) Conclusion A/O are common in suspected, confirmed and misdiagnosed asthma, and are associated with greater symptom burden independent of objective disease markers. Symptom-based tools cannot reliably distinguish asthma from comorbidity-driven symptoms, leading to potential overtreatment. Addressing non-asthma related treatable traits can improve outcomes and reduce unnecessary steroid use. Objective biomarkers beyond subjective symptom measures are needed to enable personalised pathophysiology-based asthma management.",
  "authors": [
    {
      "affiliations": [
        "University of Manchester, Manchester, UK"
      ],
      "name": "R Wang"
    },
    {
      "affiliations": [
        "Royal College of Surgeons in Ireland, Dublin, Ireland"
      ],
      "name": "C Gill"
    },
    {
      "affiliations": [
        "Royal College of Surgeons in Ireland, Dublin, Ireland"
      ],
      "name": "C Uttewill"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, UK"
      ],
      "name": "M Bennett"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, UK"
      ],
      "name": "C Murray"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, UK"
      ],
      "name": "A Simpson"
    },
    {
      "affiliations": [
        "University of Manchester, Manchester, UK"
      ],
      "name": "SJ Fowler"
    },
    {
      "affiliations": [
        "Royal College of Surgeons in Ireland, Dublin, Ireland"
      ],
      "name": "RW Costello"
    }
  ],
  "title": "M23 Obesity and anxiety impact on symptom burden in newly diagnosed and misdiagnosed asthma",
  "uid": "66fa61bf-ae54-57f5-9ef3-ba6590db495e"
}