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Development of Core Outcome Measures sets for paediatric and adult Severe Asthma (COMSA).

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journal contribution
posted on 2022-12-02, 11:50 authored by Ekaterina Khaleva, Anna Rattu, Chris Brightling, Andrew Bush, Apostolos Bossios, Arnaud Bourdin, Kian Fan Chung, Rekha Chaudhuri, Courtney Coleman, Sven-Erik Dahlén, Ratko Djukanovic, Antoine Deschildre, Louise Fleming, Stephen J Fowler, Atul Gupta, Eckard Hamelmann, Simone Hashimoto, Gunilla Hedlin, Gerard H Koppelman, Erik Melén, Clare S Murray, Charles Pilette, Celeste Porsbjerg, Katharine C Pike, Franca Rusconi, Clare Williams, Birgit Ahrens, Peter Alter, Freja Anckers, Maarten van den Berge, Katharina Blumchen, Guy Brusselle, Graham W Clarke, Danen Cunoosamy, Barbro Dahlén, Piers Dixey, Andrew Exley, Urs Frey, Erol A Gaillard, Lisa Giovannini-Chami, Jonathan Grigg, Diana Hartenstein, Liam G Heaney, Bülent Karadag, Susanne Kaul, Inger Kull, Amelia Licari, Anke H Maitland-van der Zee, Vera Mahler, Ann-Marie M Schoos, Prasad Nagakumar, Jenny Negus, Hanna Nielsen, James Paton, Mariëlle Pijnenburg, Valeria Ramiconi, Sofia Romagosa Vilarnau, Stefania Principe, Niels Rutjes, Sejal Saglani, Paul Seddon, Florian Singer, Heribert Staudinger, Steve Turner, Susanne Vijverberg, Tonya Winders, Valentyna Yasinska, Graham Roberts, COMSA working group in the 3TR consortium


Effectiveness studies with biological therapies for asthma lack standardised outcome measures. The COMSA (Core Outcome Measures sets for paediatric and adult Severe Asthma) working group sought to develop Core Outcome Measures (COM) sets to facilitate better synthesis of data and appraisal of biologics in paediatric and adult asthma clinical studies.


COMSA utilised a multi-stakeholder consensus process among patients with severe asthma, adult, and paediatric clinicians, pharmaceutical representatives and health regulators from across Europe. Evidence included a systematic review of development, validity, and reliability of selected outcome measures plus a narrative review and a pan-European survey to better understand patients' and carers' views about outcome measures. It was discussed using a modified GRADE Evidence to Decision framework. Anonymous voting was conducted using predefined consensus criteria.


Both adult and paediatric COM sets include forced expiratory volume in 1 s (FEV1) as z scores, annual frequency of severe exacerbations and maintenance oral corticosteroid use. Additionally, the paediatric COM set includes the Paediatric Asthma Quality of Life Questionnaire, and Asthma Control Test (ACT) or Childhood-ACT while the adult COM includes the Severe Asthma Questionnaire and the Asthma Control Questionnaire-6 (symptoms and rescue medication use reported separately).


This patient-centred collaboration has produced two COM sets for paediatric and adult severe asthma. It is expected that they will inform the methodology of future clinical trials, enhance comparability of efficacy and effectiveness of biological therapies, and help assess their socioeconomic value. COMSA will inform definitions of non-response and response to biological therapy for severe asthma.


Author affiliation

Department of Respiratory Sciences, University of Leicester


  • AM (Accepted Manuscript)

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The European respiratory journal




European Respiratory Society (ERS)





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