TABLE 1.
Categories of the asthma patient population
| Population category | Description |
|---|---|
| Severity of the disease | Based on GINA guidelines [1]: 1) Non-severe asthma: collectively include mild, moderate, uncontrolled and difficult-to-treat asthma patients (the latest being a subset of uncontrolled asthma) 2) Severe asthma (4–5% of patients): lack of disease control despite optimal patient adherence to (optimised) high treatment intensity [1, 26] |
| Patient adherence to treatment plan # | 1) Suboptimal adherence: adherence to <80% of their treatment plan (subscription filling level <80%)¶ 2) Optimal adherence: adherence to at least 80% of their treatment plan (subscription filling level ≥80%)+ |
| Patient symptom control | 1) Controlled symptoms: patients who do not experience symptoms in the previous year or only have minor occurrences that do not require extensive medical intervention or affect individuals' daily lives 2) Uncontrolled symptoms: patients with worsening of symptoms or exacerbations that require medical intervention and interrupt patients’ daily lives |
| Uncontrolled symptoms stage | Patients with uncontrolled symptoms (severe and non-severe) can experience the following: 1) Mild worsening of symptoms: mild symptoms (such as increased cough, shortness of breath or night waking), resolving without treatment or requiring self-administration of a few doses of reliever medication via a reliever inhaler [1] 2) Self-managed exacerbations: severe worsening of symptoms requiring self-administration of a greater intake of a reliever medication via a reliever inhaler (may also require primary care unplanned appointments/interventions) 3) Exacerbations requiring secondary care: worsening of symptoms for which self-administration of inhaled medication is not sufficient. Depending on the severity, patients might require secondary care interventions (e.g. ambulance, hospital admission) |
| Mortality | A proportion of patients that require secondary care would also not survive the exacerbation§ |
GINA: Global Initiative for Asthma. #: defined based on available evidence, in which prescription filling is picking up the prescription by the patient in a year [27, 28]; ¶: assuming that a uniform distribution of adherence within this population results in a 40% average adherence to medication (we assumed that patients still purchase a higher proportion of medication compared to what they use, i.e. that patients purchase 60% of the medication prescribed by their treatment plan); +: assuming that a uniform distribution of adherence within this population results in a 90% average adherence; §: there is potentially a small number of patients that die of asthma without having the time to ask for medical intervention; however, these were expected to be negligible compared to the total number of asthma-related deaths.