Table 3

Characteristics of PSPs described in studies of their impact

ReferencePopulation (N)InterventionResultsLimitations
Bègne et al45Severe asthma (119)Group 1:
  • Omalizumab (N=25).

  • Azithromycine (N=8).

  • Bronchial thermoplasty (N=10).

  • Oral corticosteroids (N=4).

  • Azathioprine (N=2).

Group 2:
  • Pulmonary rehabilitation (N=3).

  • Nocturnal ventilation for obstructive sleeping apnoea (N=4).

  • Smoking cessation (N=1).

  • Psychiatric care (N=1).

  • Nutritional follow-up (N=1).

  • Sleeve gastrectomy (N=1).

  • Hyperventilation treatment (N=7).

Group 3:
  • No step 5 treatments

  • No comorbidity treatments

  • All three groups had increases in the proportion of patients to achieve an ACT score of 20 or more, indicating asthma control. In Group 1, 8.1% of patients had scores of ≥20 at baseline, compared with 19% at 6 months and 22.4 at 12 months. The same values were 0 at baseline, 6.2% at 6 months, 12.5% at 12 months for Group 2, and 11.1% at baseline, 20% at 6 months, and 29.6% at 12 months for Group 3.

  • Three patients in Group 3 did not receive any add-on therapies but still improved asthma control, indicating that patient education alone can result in positive outcomes.

  • There was a significant reduction in the number of patients with hospitalisations for all three groups combined (25.2% at baseline compared with 8.4% at 12 months, p<0.001).

  • There were no significant changes in FEV1. Oral corticosteroid use significantly decreased overall and in Group 1, but there was no change in the proportion of patients receiving maintenance oral corticosteroids.

Groups 1 and 2 were heterogenous, complicating the interpretation of study results.
Estrada et al33–36Persistent severe asthma (237)Omalizumab
  • ACT scores improved from a mean of 17.5 at baseline to 22.1 after 1 year (p<0.0001).

  • HRQoL (as measured with the WHOQOL-BREF) improved in 69% of cases (from mean 67 at baseline to 77 after 1 year, p=0.028), especially in the social-environmental dimension.

  • The proportion of patients who had at least one emergency (defined as a use of emergency services due to asthma exacerbation) decreased from 21% before the educational programme to 14% after (p=0.045). The number of emergencies per 100 patients was 40 before and 24 after programme implementation (p=0.04).

  • The proportion of patients with hospitalisations decreased from 14.8% in the year preceding the study to 8% in the year following the study.

  • Of the patients who were categorised as having uncontrolled asthma at baseline, 57% had well-controlled asthma and 21% had fully-controlled asthma at the end of the study period (p<0.000).

  • The perception of healthcare improved in 70% of patients.

The role of the PSP in achieving positive patient outcomes is unclear.
Elsey et al32Severe asthma56Prevention inhaler to accompany mepolizumab
  • After 12 months, 10% of patients were non-adherent (collected less than 80% of their inhaler prescriptions). The non-adherent patient group had a higher ACQ-7 score at 12 months, indicating less asthma control.

The impact of the PSP on patient adherence is unclear and is discussed only in the conclusions.
Makhecha et al31Severe asthma, paediatric23Mepolizumab
  • FEV1, oral corticosteroid use, and the number of unscheduled healthcare visits were maintained after 3 months of participation. ACT scores improved from a median of 18 (IQR 13–22) to 23 (IQR 19–24), p=0.00005. PAQLQ scores improved from a median of 6.5 (range 4.6–6.8) to 6.6 (range 6.3–6.8), p=0.003. Patient and caregiver responses were quite positive.

The short duration of the study and the small sample size resulted in an inability to statistically compare some variables (oral corticosteroid use, the number of hospital visits, and outpatient visits).
Morris et al17Severe eosinophilic asthma, adults, (746)Benralizumab
  • Mean ACQ-6 score improved from a baseline of mean 2.7 (SD 1.5, n=186) to 1.6 (SD 1.3, n=302) after 48 weeks.

  • The proportion of patients using oral corticosteroids was reduced, from 48.4% at baseline (n=186) to 34.8 (n=306).

  • Treatment discontinuation rates were low: 3.0% and 5.8% of evaluable patients discontinued benralizumab at 24 and 48 weeks, respectively.

Some discontinuations occurred before the study index date. There were low data capture rates for some baseline variables (oral corticosteroid use, ACQ-6 scores).
Benfante et al37Adults with severe asthma treated with biological agents56Omalizumab (14%), mepolizumab (22%), benralizumab (60%), dupilumab (4%)
  • Transition to self-administration and home monitoring with support from PSPs did not impact patient’s outcomes and enabled efficient and continued care for patients with severe asthma during COVID-19 pandemic.

  • Mean ACT score before and after introduction of at-home administration and PSPs were 17.8 and 18.4, respectively.

  • Mean ACQ score before and after introduction of at-home administration and PSPs were 1.58 and 1.48, respectively.

  • Mean AQLQ score before and after introduction of at-home administration and PSPs were 4.57 and 4.59, respectively.

No formal statistical methods were applied to compare the outcomes before and after at-home administration. The effect of participating in the PSPs is unclear as it can be confounded by other factors.
  • ACQ, Asthma Control Questionnaire; ACT, Asthma Control Test; FEV1, forced expiratory volume in one second; GINA, Global Initiative for Asthma; HRQoL, health-related quality of life; IgE, immunoglobulin E; N, number; NR, not reported; PAQLQ, Paediatric Asthma Quality of Life Questionnaire; PRO, patient-reported outcome; PSP, patient support programme; WHOQOL-BREF, WHO Quality of Life assessment short version.