A research network formed by Nanyang Technological University, Singapore's (NTU Singapore) Lee Kong Chian School of Medicine (LKCMedicine), Changi General Hospital (CGH), Singapore General Hospital (SGH), and Tan Tock Seng Hospital (TTSH) has set up the Singapore Severe Asthma Registry (SSAR), the first of its kind in the country.
This national registry also joins the International Severe Asthma Registry (ISAR), making it the largest international research collaboration in the history of respiratory medicine in Singapore.
The SSAR is the first multi-center, large-scale registry of severe asthma patients in Singapore. It aims to improve understanding of severe asthma, collect evidence of treatment effectiveness and safety, and identify predictors of treatment success.
The registry will be managed by The Academic Respiratory Initiative for Pulmonary Health (TARIPH), a research network spearheaded by NTU's LKCMedicine.
Co-Chair of TARIPH and LKCMedicine Assistant Dean (Faculty Affairs) Associate Professor Sanjay H. Chotirmall, Provost's Chair in Molecular Medicine, said: "Severe asthma affects one in 20 individuals with asthma. This group of patients experience higher treatment burden and differing clinical trajectories, necessitating us to evaluate if and how Asian patients may be different and whether there are better ways to manage and treat this important condition."
"Developing a national registry of this kind fulfills a key mission of TARIPH to bring research to patients through partnerships. Being part of an international registry gives us rich data upon which to improve outcomes for Singaporeans with severe asthma," said Assoc Prof Chotirmall.
Associate Professor Mariko Koh, Senior Consultant in the Department of Respiratory and Critical Care Medicine at SGH, chairs the SSAR workgroup within TARIPH.
Assoc Prof Mariko Koh said: "SGH has over the years piloted various initiatives to improve asthma care for patients, especially those with severe asthma, as a number of them return frequently to the Emergency Department when they get an attack. Like other chronic respiratory diseases, severe asthma presents differently across patients in its underlying inflammation and response to treatment. There is no one treatment or intervention that works for all patients. The formation of SSAR will not only enable us to find better ways to deliver more personalized, targeted, and effective treatment plans for patients, but we will also better understand the burden of severe asthma in Singapore and introduce interventions to address issues at a systemic level."
This joint initiative by LKCMedicine and the hospitals across Singapore to advance research into severe asthma is timely as the burden of disease is high. By partnering with hospitals and respiratory medicine specialists to set up the Singapore Severe Asthma Registry, we can find better solutions to treat severe asthma. At the same time, the Registry gives us a unique opportunity to look at how severe asthma affects the Asian population differently, thereby leading to strategies tailored for our population."
Professor Joseph Sung, NTU's Senior Vice President (Health and Life Sciences) and Dean of NTU's LKCMedicine
Associate Professor John Arputhan Abisheganaden, Head and Senior Consultant in the Department of Respiratory and Critical Care Medicine at TTSH and TARIPH's co-chair, said: "The Singapore Severe Asthma Registry will go a long way towards identifying asthma patients who are at high risk, and providing us with deeper insights from bench to bedside in improving the care and management of these patients. Linking up with the international registry will also help enhance our global perspective and understanding of the condition in the Singapore context."
Adjunct Associate Professor Augustine Tee, Deputy Chairman Medical Board (Medical) and Senior Consultant, Department of Respiratory & Critical Care Medicine at CGH, said: "The Singapore Severe Asthma Registry will greatly enable healthcare professionals to study the characteristics of people with severe asthma locally. As our public hospitals become more involved in improving the population health of Singaporeans, new insights gathered from this collaboration will be useful in managing patients with severe asthma in the community. Registry data of this prevalent disease will help enhance detection and personalise effective asthma treatments to enhance the quality of life of people with severe asthma. Being part of the International Severe Asthma Registry provides local clinicians and scientists with the opportunities for international collaborations in asthma and other respiratory diseases."
Collating data to study different severe asthma patient demographics
Set up in April 2022, SSAR aims to understand the burden of severe asthma in Singapore, address clinical and knowledge gaps of severe asthma, reduce complications and improve care and outcomes. The real-world evidence gathered has the potential to inform policy decision-making and guideline implementation.
The registry has collected data from 139 severe asthma patients to date and aims to register 200 patients by the end of the year. The data collected, which is anonymized, includes demography, medical history, exacerbation history, treatment plan and biomarkers such as lung spirometry test results, full blood count and other clinical parameters.
Crucially, the researchers will be able to compare the data of Asian patients with non-Asian patients from other countries.
"Current clinical guidelines for treatment have been derived from evidence predominantly from non-Asian patients," said Assoc Prof Chotirmall. "There is emerging evidence from a range of lung diseases that Asian and non-Asian patients respond differently to treatment and have lung diseases that behave differently. This is likely due to differences in genetics, environmental exposures (such as allergens, air quality and climate), health-seeking behaviors, and practices in health systems."
TARIPH researchers can tap on SSAR's data to address important research questions in severe asthma, improve early diagnosis for patients and promote best practices in severe asthma care.
One key research focus is the choice of treatment for severe asthma patients. An area of concern is the high oral corticosteroid use among severe asthmatics in Singapore.
Oral corticosteroids are commonly used for acute asthma flare-ups and as maintenance for patients with severe asthma. However, long-term and frequent oral corticosteroid use is associated with side effects such as the development of diabetes, osteoporosis, and kidney disease, along with increased risk of heart attack, strokes, pneumonia, and glaucoma.
Through the data collected, the researchers aim to understand how the high oral steroid usage is affecting the local severe asthmatic population and identify ways to minimise steroid burden and reduce complications.
Other research topics to be investigated include determining the predictors of treatment success, outcomes of personalised therapies, the use of biologics for treatment, and studying undiagnosed severe asthma in primary care.
Information sharing across researchers from 26 countries
The new Singapore registry will be part of the International Severe Asthma Registry (ISAR), the first global partnership of researchers from 26 countries. Each national registry shares their data with the ISAR for research in understanding how severe asthma affects patients differently in different geographical populations.
The joint initiative allows national registries to retain ownership of their own data while sharing data with ISAR for ethically approved global research. By being part of ISAR, researchers and clinicians from TARIPH can tap on data from other countries for comparison of patient characteristics and responses to treatment in Singapore with patients in other countries.
The ISAR is one of the many efforts by the Observational and Pragmatic Research Institute (OPRI), an academic research institution based in Singapore that strives to improve the lives of patients through real-life research.
"I am delighted by SSAR's collaboration with ISAR," said Professor David Price, the Director of OPRI Singapore who leads the ISAR. "It is going to be an incredible step towards the advancement of severe asthma research on a global scale and I cannot wait to see the addition of Singaporean perspectives to our current knowledge."
"With their rigid settings and strict inclusion/exclusion criteria, clinical trials could exclude the average patient. This is why registries such as SSAR and ISAR are so important. Their extensive data bridges the gap between clinical trials and the real world. With data from 12,772 patients from 26 countries, ISAR has offered real-life findings and insights that clinical trials have missed. By joining ISAR, SSAR will enter a mutually beneficial relationship where it can add to and benefit from ISAR's research."