Patient-centred outcomes in severe asthma: fatigue, sleep, physical activity and work.

Severe asthma places a significant burden on patients, with recent research revealing overlooked patient needs extending beyond physical symptoms. To optimise the patient-centred approach to managing severe asthma, it is crucial to deepen our understanding of these needs. This review examines the prevalence and impact of four prioritised patient needs in severe asthma, namely fatigue, sleep disturbances, physical inactivity and reduced presence and productivity at work. It explores how these factors relate to classic asthma outcomes and quality of life, and the potential impact of interventions. Fatigue affects up to 90% of patients, while sleep difficulties impact 70-75% of severe cases, contributing to impaired daily function and quality of life. Although both are linked to asthma control, the cause-and-effect relationship remains unclear, making it clinically intriguing to investigate whether interventions targeting fatigue or sleep problems affect asthma control. In asthma patients, physical inactivity occurs both as consequence and contributing factor to uncontrolled disease. Interventions promoting physical activity improve asthma control and quality of life, suggesting a potential role in severe asthma management. Finally, work productivity loss, notably present in severe asthma cases, strongly correlates with asthma control and exacerbations. While biologic therapies show potential to reverse this loss, their effects on physical activity, fatigue and sleep disturbances warrant further investigation. Nonpharmacological interventions targeting these needs, such as pulmonary rehabilitation and behavioural therapies, may provide opportunities to enhance patients' well-being. Overall, this review highlights significant gaps in understanding patient-centred aspects of severe asthma, urging for research on comprehensive interventions to improve patients' lives.