Predicting episodes of poor asthma control in treated patients with asthma - 20/08/11
, Charles G. Irvin, PhD c, John G. Mastronarde, MD a, Nicola A. Hanania, MD d, Mario Castro, MD, MPH e, N.R. Anthonisen, MD, PhD ffor the American Lung Association Asthma Clinical Research Centers
Reprint requests: David M. Shade, JD, Johns Hopkins School of Public Health, Center for Clinical Trials, 615 N Wolfe Street, Room 5025-D, Baltimore, MD 21205.Columbus, Ohio, Baltimore, Md, Burlington, Vt, Houston, Tex, St Louis, Mo, and Winnipeg, Manitoba, Canada
Abstract |
Background |
Asthma exacerbations are dangerous, expensive, and difficult to anticipate.
Objective |
To characterize patients with asthma who had asthma episodes and exacerbations during 4 weeks of observation.
Methods |
A total of 2032 volunteers with asthma (age, 3-64 years; 62% female subjects) were studied over two 2-week intervals after flu vaccine and placebo. Baseline data, including several asthma questionnaires, were analyzed for prediction of subsequent asthma events as recorded on diaries detailing peak flow, medication use, and health care use.
Results |
During 28 days of diary collection, 43.2% of participants had at least 1 episode of poor asthma control. Most episodes were characterized by increased use of rescue medications or reductions in peak flow, but nearly 15% of participants had exacerbations characterized by use of systemic corticosteroids, unscheduled health care visits, or both. Episode frequency was highest in children <10 years of age. Additional risk factors were smoking, African American ethnicity, low lung function, and past history of severe asthma. The best predictors were symptom questionnaires, and a simple questionnaire concerning the preceding 2 weeks worked as well as more complex questionnaires or those reflecting longer periods. In regression analyses, questionnaire results, smoking, lung function, ethnicity, and asthma history all were associated with asthma episodes in people older than 10 years, whereas only asthma history was predictive in those <10 years.
Conclusion |
Symptom questionnaires are predictive of subsequent asthma episodes in people older than age 10 years, but not in younger people.
Clinical implications |
Simple assessments may be helpful in identifying patients most at risk for future asthma episodes.
Le texte complet de cet article est disponible en PDF.Key words : Asthma exacerbations, asthma symptom questionnaires, asthma control
Abbreviations used : AS-2, AS-52, ASUI, BMI, EPAC, GINA, GINAMED, ICS, IRA, OCS, RR
Plan
| Supported by the American Lung Association. Disclosure of potential conflict of interest: K. McCoy has received grant support from Chiron and Inspire Pharmaceuticals. C. G. Irvin has consulting arrangements with Biogen, MethaPharm, Merck, and Sepracor; has received grant support from GlaxoSmithKline; and is on the speakers’ bureau for Merck. J. G. Mastronarde has received grant support from Pfizer and is on the speaker’s bureau for GlaxoSmithKline. N. A. Hanania has received grant support from GlaxoSmithKline and Sepracor and is on the speakers’ bureau for GlaxoSmithKline and Genentech. N. R. Anthonisen has served on advisory boards for GlaxoSmithKline and Altana and has received honoraria from GlaxoSmithKline. The rest of the authors have declared that they have no conflict of interest. |
Vol 118 - N° 6
P. 1226-1233 - décembre 2006 Retour au numéro
Article précédent
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