Asthma diagnosis and treatment
Predicting episodes of poor asthma control in treated patients with asthma

https://doi.org/10.1016/j.jaci.2006.09.006Get rights and content

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.

Section snippets

Subjects and design

Over the period from September 15 to November 30, 2000, a total of 2032 patients with asthma were recruited by 19 centers of the American Lung Association Asthma Clinical Research Centers to evaluate the safety of influenza vaccine with respect to asthma exacerbations. The study was a randomized, double-masked, crossover trial of influenza vaccine and placebo administration (vaccine followed by placebo or placebo followed by vaccine) separated by 2 to 4 weeks (mean, 22 days). Patients were

Results

Of 2032 patients initially enrolled and assigned to vaccine administration, 2009 (98.9%) received both injections, 1952 (96.1%) received both injections and completed 14-day diaries after each postinjection period, and 1949 also completed baseline questionnaires. The group with complete diary data (28 days) and baseline questionnaires was included in our current analysis, combining postvaccine and postplacebo data. Peak flow was measured at the time of each injection in 1821 (93.3%) and FEV1

Discussion

In our study of patients with asthma recruited for a relatively short-term trial of influenza vaccine, we found factors suggestive of an increased risk of subsequent episodes of poor asthma control and exacerbation. We studied a large group of physician-diagnosed patients with asthma with wider ranges of age, demographics, and disease severity than are usually reported. Although we excluded individuals with current or recent exacerbations, and individuals under active therapy for an

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    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.

    Participating centers listed in Appendix B.

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