Abstract
Background: Clinicians are increasingly recognising severe asthma
patients in whom biologicals and other add-on therapies lead to dramatic
improvement. Because there is no agreed upon super-responder (SR)
definition at present, we surveyed severe asthma experts using a
modified Delphi process in order to define an international
consensus-based definition of a severe asthma ‘super-responder’.
Methods: The Delphi panel comprised 81 participants (94% specialist
pulmonologists or allergists) from 24 countries and consisted of 3
iterative online voting rounds. Consensus on individual items, whether
acceptance or rejection, required at least 70% agreement by panel
members. Results: Consensus was achieved that the SR definition should
be based on improvement across 3 or more domains assessed over 12
months. Major SR criteria included exacerbation elimination, a large
improvement in asthma control (≥ 2x the minimal clinically important
difference) and cessation of maintenance of oral steroids (or weaning to
adrenal insufficiency). Minor SR criteria comprised a 75% exacerbation
reduction, having well controlled asthma and a 500mL or greater
improvement in FEV1. The SR definition needs to incorporate quality of
life measures, though current tools can be difficult to implement in a
clinical setting and further research is needed. Conclusions: This
international consensus-based definition of severe asthma super
responders is an important prerequisite for better understanding
super-responder prevalence, predictive factors and the mechanisms
involved. Further research is needed to understand the patient
perspective and measure quality of life more precisely in
super-responders.