Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: Role of predictors in the setting of high adherence

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY

卷:124

Article

Gruchalla, Rebecca S.¹  Sampson, Hugh A.²  Matsui, Elizabeth³  David, Gloria⁴  Gergen, Peter J.⁵  Calatroni, Agustin⁴  Brown, Mark⁶  Liu, Andrew H.^7,8  Bloomberg, Gordon R.⁹  Chmiel, James F.¹⁰  Kumar, Rajesh¹¹  Lamm, Carin¹²  Smartt, Ernestine⁵  Steinbach, Suzanne F.¹³  Stone, Kelly D.¹⁴  Szefler, Stanley J.^7,15 

[1] Univ Texas SW Med Ctr Dallas, Dallas, TX 75390 USA

[2] Mt Sinai Sch Med, New York, NY USA

[3] Johns Hopkins Univ, Sch Med, Baltimore, MD USA

[4] Rho Inc, Chapel Hill, NC USA

[5] NIAID, Div Allergy Immunol & Transplantat, NIH, Bethesda, MD USA

[6] Univ Arizona, Coll Med, Tucson, AZ 85721 USA

[7] Natl Jewish Hlth, Denver, CO USA

[8] Univ Colorado, Hlth Sci Ctr, Boulder, CO 80309 USA

[9] Washington Univ, St Louis, MO USA

[10] Case Western Reserve Univ, Sch Med, Cleveland, OH USA

[11] Childrens Mem Hosp, Chicago, IL 60614 USA

[12] Columbia Univ, Coll Phys & Surg, New York, NY USA

[13] Boston Univ, Sch Med, Boston, MA 02215 USA

[14] Childrens Natl Med Ctr, Washington, DC 20010 USA

[15] Univ Colorado, Denver Sch Med, Boulder, CO 80309 USA

关键词: Asthma;    exhaled nitric oxide;    inner-city;    allergic sensitization;    airway inflammation;    asthma severity;   

DOI  :  10.1016/j.jaci.2009.05.036

来源: Elsevier

【 摘 要 】

Background: With the expanding effort to provide guidelines-based therapy to adolescents with asthma, attention must be directed to evaluating which factors predict future asthma control when guidelines-based management is applied. Objective: We evaluated the role of fraction of exhaled nitric oxide in parts per billion, markers of allergic sensitization, airway inflammation, and measures of asthma severity in determining future risk of asthma symptoms and exacerbations in adolescents and young adults participating in the Asthma Control Evaluation study. Methods: Five hundred forty-six inner-city residents, ages 12 through 20 years, with persistent asthma were extensively evaluated at study entry for predictors of future symptoms and exacerbations over the subsequent 46 weeks, during which guidelines-based, optimal asthma management was offered. Baseline measurements included fraction of exhaled nitric oxide in parts per billion, total IgE, allergen-specific IgE, allergen skin test reactivity, asthma symptoms, lung function, peripheral blood eosinophils, and, for a subset, airway hyperresponsiveness and sputum eosinophils. Results: The baseline characteristics we examined accounted for only a small portion of the variance for future maximum symptom days and exacerbations-11.4% and 12.6%, respectively. Future exacerbations were somewhat predicted by asthma symptoms, albuterol use, previous exacerbations, and lung function, whereas maximum symptom days were predicted, also to a modest extent, by symptoms, albuterol use, and previous exacerbations, but not lung function. Conclusion: Our findings demonstrate that the usual predictors of future disease activity have little predictive power when applied to a highly adherent population with persistent asthma that is receiving guidelines-based care. Thus, new predictors need to be identified that will be able to measure the continued fluctuation of disease that persists in highly adherent, well-treated populations such as the one studied. (J Allergy Clin Immunol 2009;124:213-21.)

【 授权许可】

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