New tool helps doctors identify asthma patients who need extra care

Southampton researchers have led the development of a new scoring system to guide care for people with asthma that is difficult to treat.

WATCH (Wessex AsThma CoHort of difficult asthma) is a real-world research study based at Southampton and the Isle of Wight. It allows patients with difficult-to-treat asthma to take part in research alongside their clinical care.

First established 10 years ago, it forms part of the NIHR Southampton Biomedical Research Centre (BRC)’s Respiratory and Allergy research theme. Over 700 patients have now joined WATCH. It has led to many international research collaborations. It has also produced a series of results that have given new insights into the nature of more severe asthma and how that might be better treated.

The latest study from WATCH is the first to assess the effect of having multiple health conditions (multimorbidity) on difficult-to-treat asthma. It has been published in The Lancet Respiratory Medicine.

The results have now been used to the create the MiDAS scoring system. This helps doctors identify which patients with this type of asthma are most likely to need extra care.

Identifying patients most in need

Asthma is a condition that makes it hard to breathe. Some people have a type that does not get better easily, even with treatment.

These patients often have other health conditions too, such as anxiety or being overweight.

Having multiple health conditions at the same time like this is known as ‘multimorbidity’. Until now, doctors haven’t had a good way to measure how this affects asthma.

The WATCH study found that multimorbidity is common in patients with difficult-to-treat asthma. It also showed this is associated with worse asthma control, a higher risk of their symptoms deteriorating, a poor quality of life and more inflammation.

Developing the scoring system

The researchers found that there were seven common health problems that were associated with worse asthma severity in patients with difficult-to-treat asthma. They used these results to create the Multimorbidity in Difficult Asthma Score (MiDAS) initially working with colleagues in Serbia.

The higher the score, the more likely a person is to have worse asthma symptoms, feel more anxious or depressed, and have a lower quality of life.

Working with researchers at four overseas centres across three continents, the score was then tested on people from Australia, Singapore and the USA. It was found to work well in these other countries.

Treating the whole person

Doctors can now use MiDAS to quickly spot which asthma patients might need more help to address wider healthcare needs alongside their asthma. The researchers hope this will lead to better, more personalised care.

The WATCH study is led by Southampton’s Professor Ramesh Kurukulaaratchy, Dr Anna Freeman and Professor Hans Michael Haitchi.

Professor Kurukulaaratchy said: “Our findings from the WATCH study show that purely focussing on lung health is not enough to treat patients with this type of asthma.

“Instead, doctors need to treat the whole person, taking all of their conditions into consideration. Now, with the MiDAS scoring system, they are able to do this easily.”