Consistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:124

Article

Haselkorn, Tmirah¹  Fish, James E.¹  Zeiger, Robert S.²  Szefler, Stanley J.³  Miller, Dave P.⁴  Chipps, Bradley E.⁵  Simons, F. Estelle R.⁶  Weiss, Scott T.⁷  Wenzel, Sally E.⁸  Borish, Larry⁹  Bleecker, Eugene R.¹⁰ 

[1] Genentech Inc, San Francisco, CA 94080 USA

[2] Kaiser Permanente So Calif, Dept Allergy, San Diego, CA USA

[3] Natl Jewish Hlth, Dept Pediat, Denver, CO USA

[4] ICON Clin Res, San Francisco, CA USA

[5] Capital Allergy & Resp Dis Ctr, Sacramento, CA USA

[6] Univ Manitoba, Winnipeg, MB, Canada

[7] Harvard Univ, Sch Med, Channing Lab, Boston, MA 02115 USA

[8] Univ Pittsburgh, Sch Med, Asthma Inst, Pittsburgh, PA USA

[9] Univ Virginia Hlth Syst, Charlottesville, VA USA

[10] Wake Forest Univ Hlth Sci, Winston Salem, NC USA

关键词: Asthma;    asthma guidelines;    impairment domain;    risk;    exacerbations;    health care use;    asthma control;    The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study;   

DOI  :  10.1016/j.jaci.2009.07.035

来源: Elsevier

【 摘 要 】

Background: Identification of patients at risk for asthma exacerbations can assist physicians in addressing disease management and improve asthma-related health outcomes. Objective: We sought to evaluate whether level of impairment, as defined by the 2007 asthma guidelines, predicts risk for future asthma exacerbations. Methods: The study included children aged 6 to 11 years (n = 82) and adolescent/adult patients aged 12 years and older (n = 725) from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens study with data representing all components of the impairment domain of the asthma guidelines at baseline, month 12, and month 24. Patients were categorized into 2 cohorts: (1) consistently very poorly controlled (VPC) asthma from baseline through 2 years of follow-up and (2) improved from VPC asthma at baseline (including patients who improved to not well-controlled or well-controlled asthma), with improvement maintained through 2 years of follow-up. Odds ratios (ORs) and 95% CIs for risk of asthma exacerbations at month 30 were generated by using multivariable logistic regression by age group. Results: After adjustment, children with consistently VPC asthma over the 2-year period demonstrated a 6-fold increased risk of hospitalization, emergency department visit, or corticosteroid burst (OR, 6.4; 95% CI, 1.2-34.5) compared with the improved group. Adolescent/adult patients with consistently VPC asthma were more likely to have a corticosteroid burst (OR, 2.8; 95% CI, 1.7-4.8) or have a hospitalization, emergency department visit, or corticosteroid burst (OR, 3.2; 95% CI, 1.9-5.3). Conclusions: Consistently VPC asthma, as defined by the impairment domain of the 2007 asthma guidelines, is strongly predictive of future asthma exacerbations. (J Allergy Clin Immunol 2009;124:895-902.)

【 授权许可】

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