{
  "abstract": "Introduction A treatable traits approach enables personalised management of asthma phenotypes, demonstrating improved patient outcomes. 1 The BREATHE study aims to characterise patients with suspected or established complex airways disease using multidimensional assessment to improve diagnosis and management based on treatable traits, including pulmonary, extra pulmonary and and risk factors domains.1 Methods BREATHE is a prospective, longitudinal cohort study recruiting adult patients referred to a UK tertiary asthma service with suspected or confirmed airways disease(REC: 23/LO/0279). Baseline assessment includes protocolised clinical history, examination, pulmonary function tests, imaging, multidisciplinary input and additional specialist investigations including continuous laryngoscopy examination. Here we provide a descriptive analysis of the first 100 unselected participants.Results Recruitment started in November 2023. Of the first 100 patients, 69% were female; median age 54 yrs[42–65]. Most referrals came from primary (51%) and secondary care (40%). 6% were on an asthma biologic at referral. 74% of the 86 patients referred with severe asthma had this diagnosis confirmed following assessment. This group had high Th2 inflammation (raised eosinophils(61%) and FeNO(55%)) and ≥3 exacerbations/year(64%) despite 80% being on high dose inhaled corticosteroid (ICS) at referral. Treatable traits were common in confirmed asthma, 36% had symptoms of breathing pattern disorder (BPD) and 30% had symptoms of inducible laryngeal obstruction (ILO) and were referred for assessment. 26% (n=22) of severe asthma referrals did not have a confirmed asthma diagnosis following assessment. This group still had a high burden of OCS (55% ≥3) but lower biomarkers of Th2 inflammation when compared to the asthma confirmed group (eosinophils p≤0.001). Comorbid reflux and anxiety/depression featured highly in non-confirmed asthma, with 50% and 59% of patients referred for ILO or BPD assessment respectively.Abstract S51 Table 1Domain-based assessment of all asthma referrals comparing characteristics of those with confirmed asthma and those that need further investigation/diagnosis in doubt Asthma Confirmed n=64 Asthma not confirmed n=22 p- value CHARACTERISTICS Gender Female n (%) 44 (68.8) 19 (86.4) 0.183 Age Mean (SD) 51.2 (17.1) 51(13.6) 0.96 IMD (quintile) Most deprived 5(7.8) 3(13.9) 0.468 2 17(26.6) 2(9.1) 3 11(17.2) 4(18.2) 4 15 (23.4) 7(31.8) Least deprived 15(23.4) 4(18.2) Ethnicity White British n(%) 56 (87.5) 22 (100) 0.188 Annualised OCS use 0 n (%) 10 (15.6) 5 (22.7) 1 to 2 n (%) 11 (17.1) 5 (22.7) ≥3 n (%) 41 (64) 12 (54.5) Mean(SD) 3.4(2.5) 3.0(2.9) 0.602 Evidence of PEFR variability or reversibility n (%) 18(28.1) 1 (4.5) 0.045 CT features of airways disease ≥1 n (%) 15 (23.4) 2 (9.1) 0.215 AIRWAYS ASSESSMENT Eosinophils last 12 m ≥0.15 n (%) 55 (85.9) 10 (45.4) ≥0.3 n (%) 39 (60.9) 3 (13.6) 0.001 Eosinophils ever ≥0.15 n (%) 62 (96.8) 17 (77.7) ≥0.3 n (%) 50 (78.1) 8 (38.8) 0.001 FeNO/ppb ≥25 n (%) 35 (54.7) 6 (27.3) 0.083 COMORBIDITY ASSESSMENT Cardiac n (%) 23 (35.9) 8 (36.3) 1 Atopy n (%) 43 (67.1) 8 (36.3) 0.018 ENT incl. rhinitis n (%) 25 (39.1) 4 (18.2) 0.127 Chronic infection n (%) 14 (21.8) 0 (0) 0.039 Reflux n (%) 32 (50) 12 (54.5) 0.904 Referred for ILO assessment n (%) 19 (29.6) 13 (59) 0.027 Referred for BPD assessment n (%) 23 (35.9) 11 (50) 0.362 Depression/Anxiety n (%) 20 (31.2) 12 (54.5) 0.09 RISK FACTORS Poor adherence n (%) 9 (14) 2 (9) 0.816 High BMI (≥30 kg/m2 ) n (%) 13 (20.3) 7 (31.8) 0.418 Smoking status Current smoker n(%) 4 (6.2) 0 (0) 0.5 Ex-smoker n (%) 23 (35.9) 6 (27.2) 0.568 BMI, Body mass index; BPD, Breathing pattern disorder; CT, computed tomography, ENT, ears nose and throat; FeNO, Fraction exhaled nitric oxide; ILO, Inducible laryngeal obstruction; IMD, index multiple deprivation; OCS, oral corticosteroids; PEFR, Peak expiratory flow rate; ppb, parts per billion.Conclusions 26% of patients referred with severe asthma were found not to have an asthma diagnosis following multidimensional assessment. Treatable traits and comorbidities were common especially in patients with non-confirmed asthma who had significantly higher burden of mental health (54.5%) and suspected ILO (>59%). Together this highlights the value of multidimensional assessment. Longitudinal follow-up will be vital to assess the impact on longer-term outcomes.Reference Maltby S, Gibson PG, et al. Severe asthma toolkit: an online resource for multidisciplinary health professionals. BMJOpen. 2020 Mar 24;10(3):e032877.",
  "authors": [
    {
      "affiliations": [
        "Respiratory Department, North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "K Bansal"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "C Morgan"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "GW Nava"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "J Grenville"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "C Ryan"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "V Cobham"
    },
    {
      "affiliations": [
        "Respiratory Department, North Bristol NHS Trust, Bristol, UK"
      ],
      "name": "D Higbee"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "R Shrimanker"
    },
    {
      "affiliations": [
        "Academic Respiratory Unit, University of Bristol, Bristol, UK"
      ],
      "name": "JW Dodd"
    }
  ],
  "title": "S51 Multidimensional assessment in severe asthma: early findings from the bristol evaluation of novel airways diagnostics, therapies and healthcare outcomes (BREATHE) study",
  "uid": "e5a5ee91-1779-5163-adcd-2b467f954762"
}