Eric D Bateman1, Roland Buhl2, Paul M O'Byrne3, Marc Humbert4, Helen K Reddel5, Malcolm R Sears3, Christine Jenkins6, Tim W Harrison7, Santiago Quirce8, Stefan Peterson9, Göran Eriksson10. 1. Division of Pulmonology, Department of Medicine, University of Cape Town, Cape Town, South Africa. Electronic address: Eric.Bateman@uct.ac.za. 2. Pulmonary Department, Mainz University Hospital, Mainz, Germany. 3. Michael G DeGroote School of Medicine, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada. 4. Université Paris-Sud 11, Service de Pneumologie et Réanimation Respiratoire, Hôpital Antoine Béclère, APHP, Clamart, France. 5. Clinical Management Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, Australia. 6. Respiratory Group, The George Institute for Global Health, Sydney, Australia. 7. Respiratory Research Unit, City Hospital Campus, Nottingham University, Nottingham, United Kingdom. 8. Department of Allergy, Hospital La Paz Institute for Health Research (IdiPAZ), Madrid, Spain. 9. StatMind AB, Lund, Sweden. 10. Department of Respiratory Medicine and Allergology, University Hospital, Lund, Sweden.
Abstract
BACKGROUND: Identifying patients at risk of future severe asthma exacerbations, those whose asthma might be less treatment responsive, or both might guide treatment selection. OBJECTIVE: We sought to investigate predictors for failure to achieve Global Initiative for Asthma (GINA)-defined good current asthma control and severe exacerbations on treatment and to develop a simple risk score for exacerbations (RSE) for clinical use. METHODS: A large data set from 3 studies comparing budesonide/formoterol maintenance and reliever therapy with fixed-dose inhaled corticosteroid/long-acting β2-agonist therapy was analyzed. Baseline patient characteristics were investigated to determine dominant predictors for uncontrolled asthma at 3 months and for severe asthma exacerbations within 12 months of commencing treatment. The RSE, right censored at 6 months to include all 3 studies, was based on the dominant predictors for exacerbations in two thirds of the data set and validated in one third. RESULTS: Patients (n = 7446) whose symptoms were not controlled on GINA treatment steps 3 and 4 and with 1 or more exacerbations (as judged by a clinician based on patient records, history, or both) in the previous year were included. On multivariate analysis, GINA step, reliever use, postbronchodilator FEV1, and 5-item Asthma Control Questionnaire score were dominant (all P < .001) predictors for both the risk of uncontrolled asthma and severe exacerbations. Additional dominant predictors for uncontrolled asthma were smoking status and asthma symptom scores and an additional predictor for severe exacerbation was body mass index. An exponential increase in risk was observed with increments in RSE based on 5 selected predictors for exacerbations. CONCLUSION: Risk of uncontrolled asthma at 3 months and a severe exacerbation within 12 months can be estimated from simple clinical assessments. Prospective validation of these predictive factors and the RSE is required. Use of these models might guide the management of asthmatic patients.
BACKGROUND: Identifying patients at risk of future severe asthma exacerbations, those whose asthma might be less treatment responsive, or both might guide treatment selection. OBJECTIVE: We sought to investigate predictors for failure to achieve Global Initiative for Asthma (GINA)-defined good current asthma control and severe exacerbations on treatment and to develop a simple risk score for exacerbations (RSE) for clinical use. METHODS: A large data set from 3 studies comparing budesonide/formoterol maintenance and reliever therapy with fixed-dose inhaled corticosteroid/long-acting β2-agonist therapy was analyzed. Baseline patient characteristics were investigated to determine dominant predictors for uncontrolled asthma at 3 months and for severe asthma exacerbations within 12 months of commencing treatment. The RSE, right censored at 6 months to include all 3 studies, was based on the dominant predictors for exacerbations in two thirds of the data set and validated in one third. RESULTS:Patients (n = 7446) whose symptoms were not controlled on GINA treatment steps 3 and 4 and with 1 or more exacerbations (as judged by a clinician based on patient records, history, or both) in the previous year were included. On multivariate analysis, GINA step, reliever use, postbronchodilator FEV1, and 5-item Asthma Control Questionnaire score were dominant (all P < .001) predictors for both the risk of uncontrolled asthma and severe exacerbations. Additional dominant predictors for uncontrolled asthma were smoking status and asthma symptom scores and an additional predictor for severe exacerbation was body mass index. An exponential increase in risk was observed with increments in RSE based on 5 selected predictors for exacerbations. CONCLUSION: Risk of uncontrolled asthma at 3 months and a severe exacerbation within 12 months can be estimated from simple clinical assessments. Prospective validation of these predictive factors and the RSE is required. Use of these models might guide the management of asthmatic patients.
Authors: Wilson Quezada; Eun Soo Kwak; Joan Reibman; Linda Rogers; John Mastronarde; William G Teague; Christine Wei; Janet T Holbrook; Emily DiMango Journal: Ann Allergy Asthma Immunol Date: 2015-12-19 Impact factor: 6.347
Authors: Stephen J Teach; Peter J Gergen; Stanley J Szefler; Herman E Mitchell; Agustin Calatroni; Jeremy Wildfire; Gordon R Bloomberg; Carolyn M Kercsmar; Andrew H Liu; Melanie M Makhija; Elizabeth Matsui; Wayne Morgan; George O'Connor; William W Busse Journal: J Allergy Clin Immunol Date: 2015-03-18 Impact factor: 10.793
Authors: Sonia Cajigal; Karen E Wells; Edward L Peterson; Brian K Ahmedani; James J Yang; Rajesh Kumar; Esteban G Burchard; L Keoki Williams Journal: J Allergy Clin Immunol Pract Date: 2016-08-17
Authors: Christine R Jenkins; Göran Eriksson; Eric D Bateman; Helen K Reddel; Malcolm R Sears; Magnus Lindberg; Paul M O'Byrne Journal: BMC Pulm Med Date: 2017-04-20 Impact factor: 3.317