BACKGROUND: Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES: To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS: Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine eosinophil count and other atopic biomarkers. The relationship of blood eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. RESULTS: A blood eosinophil cutoff point of greater than or equal to 400 cells/mm3 compared with less than 400 cells/mm3, but not 150 cells/mm3 or 300 cells/mm3, was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, -286 to 691). CONCLUSIONS: A high blood eosinophil count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.
BACKGROUND: Severe uncontrolled asthma (SUA) is associated with increased asthma exacerbations. Whether high blood eosinophil counts are related to this burden is uncertain. OBJECTIVES: To determine the relationship of blood eosinophil counts to asthma exacerbations, utilization, and cost in patients with SUA. METHODS:Patients with persistent asthma (age ≥ 12 years) were identified administratively with SUA in phase I by evidencing (1) 2 or more asthma exacerbations; (2) 6 or more medium- or high-dose dispensed canisters of inhaled corticosteroid (ICS) as monotherapy or with long-acting β2-agonist; and (3) 3 or more dispensed non-ICS controllers. Of the 541 patients with SUA invited to participate in the prospective phase II follow-up study, 261 (48.2%) had blood tests (index date) to determine eosinophil count and other atopic biomarkers. The relationship of blood eosinophil cutoff points to asthma exacerbations and direct costs 1 year after the index date were determined by multivariable regression. RESULTS: A blood eosinophil cutoff point of greater than or equal to 400 cells/mm3 compared with less than 400 cells/mm3, but not 150 cells/mm3 or 300 cells/mm3, was a risk factor in the outcome year in adjusted analyses for 2 or more asthma exacerbations (risk ratio, 1.55; 95% CI, 1.02-2.35; P =.04) and any asthma emergency department visit or hospitalization (risk ratio, 2.29; 95% CI, 1.16-4.55; P =.02), but not for rate of asthma exacerbations or incremental total direct asthma costs per patient ($202; 95% CI, -286 to 691). CONCLUSIONS: A high blood eosinophil count was an independent risk factor for 2 or more asthma exacerbations or any asthma emergency department visit or hospitalization, but not direct costs in patients with SUA, possibly constrained by limited power.
Authors: Michael C Peters; David Mauger; Kristie R Ross; Brenda Phillips; Benjamin Gaston; Juan Carlos Cardet; Elliot Israel; Bruce D Levy; Wanda Phipatanakul; Nizar N Jarjour; Mario Castro; Sally E Wenzel; Annette Hastie; Wendy Moore; Eugene Bleecker; John V Fahy; Loren C Denlinger Journal: Am J Respir Crit Care Med Date: 2020-10-01 Impact factor: 21.405
Authors: Robert S Zeiger; Fagen Xie; Michael Schatz; Benjamin D Hong; Jessica P Weaver; Vishal Bali; Jonathan Schelfhout; Wansu Chen Journal: Perm J Date: 2020-12
Authors: Marjan Kerkhof; Trung N Tran; Joan B Soriano; Sarowar Golam; Danny Gibson; Elizabeth V Hillyer; David B Price Journal: Thorax Date: 2017-09-16 Impact factor: 9.139
Authors: Harold Kim; Anne K Ellis; David Fischer; Mary Noseworthy; Ron Olivenstein; Kenneth R Chapman; Jason Lee Journal: Allergy Asthma Clin Immunol Date: 2017-11-17 Impact factor: 3.406
Authors: Marjan Kerkhof; Trung N Tran; Maarten van den Berge; Guy G Brusselle; Gokul Gopalan; Rupert C M Jones; Janwillem W H Kocks; Andrew Menzies-Gow; Javier Nuevo; Ian D Pavord; Sarang Rastogi; David B Price Journal: PLoS One Date: 2018-07-25 Impact factor: 3.240