Chest
Clinical InvestigationsASTHMACausative and Contributive Factors to Asthma Severity and Patterns of Medication Use in Patients Seeking Specialized Asthma Care*
Section snippets
Patient Selection
The study population included all new adult patients initially seen in a regional university-based referral center, The Asthma Center, between the dates of January 1, 1997, and June 18, 1999. Each patient was confirmed to have asthma as defined by the American Thoracic Society, which required demonstration of reversible obstructive airway disease with a ≥ 15% decrement in predicted FEV1 as well as improvement in expiratory flow rates to ≥ 15% of predicted after inhalation of a β2-selective
Results
Between January 1, 1997, and June 18, 1999, a total of 176 patients met the inclusion criteria for the study (initial visit, presenting for asthma, and meeting criteria for diagnosis of asthma). Of these, 27 patients were excluded (17 patients had lung disease other than asthma, 3 patients had congestive heart failure, and 7 patients had other comorbidities). The study population therefore consisted of 149 patients. Of these, 97 patients (65.1%) were female, 135 patients (90.6%) were white, 13
Discussion
The primary objective of this study was to examine causative and contributive factors to asthma severity in a population of patients referred to a university-based asthma center, with the hypothesis that certain factors or a greater number of factors might be associated with more severe disease. We found that patients with moderate/severe asthma have a significantly greater overall prevalence of causative and contributive factors and were more likely to be male than female. We also confirmed
ACKNOWLEDGMENT
The authors thank Dr. Jay F. Piccirillo for assistance in study design, and Mrs. Kristy Smith for preparation of the manuscript.
References (28)
- et al.
Adult rhinosinusitis defined
Otolaryngol Head Neck Surg
(1997) - et al.
Vocal cord dysfunction
J Allergy Clin Immunol
(1996) - et al.
Difficult-to-control asthma: contributing factors and outcome of a systematic management protocol
Chest
(1993) - et al.
Prevalence of gastroesophageal reflux symptoms in asthma
Chest
(1996) - et al.
Most asthmatics have gastroesophageal reflux with or without bronchodilator therapy
Gastreoenterology
(1990) - et al.
Asthma and gastroesophageal reflux: acid suppressive therapy improves asthma outcome
Am J Med
(1996) - et al.
The role of gastroesophageal reflux in chronic cough and asthma
Chest
(1997) - et al.
Rhinosinusitis in severe asthma
J Allergy Clin Immunol
(2001) Gastroesophageal reflux and sinusitis in asthma
Clin Chest Med
(1995)- et al.
Damage of the pharyngeal mucosa and hyperresponsiveness of airway in sinusitis
J Allergy Clin Immunol
(1997)
Nasal allergen provocation induces adhesion molecule expression and tissue eosinophilia in upper and lower airways
J Allergy Clin Immunol
Indices of morbidity and control of asthma in patients exposed to environmental tobacco smoke
Chest
Associations of smoking with hospital based care and quality of life in patients with obstructive airway disease
Chest
Asthma in America Survey Project
Cited by (30)
The Allergic Asthma Phenotype
2014, Journal of Allergy and Clinical Immunology: In PracticeCitation Excerpt :Patients with allergy and with asthma may be classified as having “few, moderate, or high” symptoms,11 and cohorts of difficult-to-control or severe asthma include individuals with allergy.12-14 However, studies of patients with varying degrees of asthma severity report that allergic versus nonallergic asthma is less severe1,2,5,15-18 or that there is no association between severity and atopic status.19-22 Other reports suggest that patients with allergic versus nonallergic asthma have less need for oral glucocorticosteroids.1,2
Severe Asthma in Adults. An Orphan Disease?
2012, Clinics in Chest MedicineCitation Excerpt :An important issue in severe asthma is the presence of comorbidities, including mainly rhinosinusitis, gastroesophageal reflux disease (GERD), obstructive sleep apnea, hormonal disorders, and psychopathologies.33 Many of these conditions share common pathophysiologic mechanisms with asthma, influence the response to treatment, and lead to poor asthma control.39–41 The presence of these comorbidities was associated with the frequent-exacerbations phenotype of severe asthma in the Leiden cohort.20
Chronic rhinosinusitis: Epidemiology and medical management
2011, Journal of Allergy and Clinical ImmunologyCitation Excerpt :The presence of bacterial biofilm was also strongly associated with persistent mucosal inflammation after endoscopic sinus surgery.57 Liou et al58 examined causes and contributive factors to asthma severity in 149 asthmatic patients at an asthma specialty clinic and found that CRS was associated with more severe asthma (OR, 2.22; 95% CI, 1.08-4.60; P = .032). In a study in western Sweden, Lotvall et al59 found an association between the presence of CRS and multisymptom (more severe) asthma by using the OLIN and GA2LEN respiratory- and allergy-focused questionnaires, whereas no association was found with allergic rhinitis.
Gastroesophageal Reflux Disease
2010, Sleisenger and Fordtran’s Gastrointestinal and Liver Disease- 2 Volume Set: Pathophysiology, Diagnosis, Management, Expert Consult Premium Edition - Enhanced Online Features and PrintEconomic aspects of severe asthma
2008, Presse MedicaleCharacterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program
2007, Journal of Allergy and Clinical ImmunologyCitation Excerpt :Aspirin sensitivity, GERD, sinusitis, and pneumonia were reported more often in severe asthma. These results support smaller studies that have used similar methods of self-report to estimate prevalence of comorbid diseases in severe asthma.19,34-37 In our study, nearly 2/3 of the severe group reported a history of pneumonia and, except for baseline FEV1 % predicted, pneumonia was the strongest independent predictor of severe asthma (OR, 3.30).