MedWire News: Consistently very poorly controlled (VPC) asthma is a significant predictor for exacerbations in both children and adults, study results show.
Writing in the Journal of Allergy and Clinical Immunology, lead researcher Tmirah Haselkorn (Genentech Inc, South San Francisco, California, USA) and team explain that the “identification of patients at risk for asthma exacerbations can assist physicians in addressing disease management and improve asthma-related health outcomes.”
To investigate whether consistently VPC asthma is associated with an increased risk for exacerbations, the researchers assessed data on 82 children, aged 6–11 years, and 725 asthmatic adolescents and adults, aged 12 years and older, with initially poorly controlled asthma who participated in the 3-year Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study.
The participants were divided into two groups based on asthma control over the first 2 years of the study. The first group included patients with consistently VPC asthma over the study period, and the second group included those with initially VPC asthma, but whose disease control improved during the study.
Asthma control was assessed using the impairment domain of the 2007 National Heart, Lung, and Blood Institute (NHLBI) asthma guidelines.
The risk for exacerbations at 30 months was assessed using data on hospitalizations, emergency department visits, and corticosteroid bursts.
The researchers found that, after adjustment, children with consistently VPC asthma had a 6.4-fold increased risk for the combined endpoint of hospitalization, emergency department visits, or corticosteroid bursts at 30 months compared with children whose asthma control improved during the study period.
Among adolescents/adults, patients with consistently VPC asthma had a 3.2-fold increased risk for hospitalization or emergency department visits, and a 2.8-fold increased risk for corticosteroid bursts at 30 months compared with those whose disease control improved.
Haselkorn and team conclude: “Having consistently VPC asthma over time, as defined by the impairment domain of the 2007 NHLBI asthma guidelines, predicts future risk for asthma exacerbations. This was evidenced by significantly higher risks for the composite outcome of hospitalizations, ED visits, or corticosteroid bursts in both children and adolescents/adults who had consistently VPC asthma compared with patients who improved from VPC asthma.”
They add: “These data support the 2007 asthma guidelines' impairment domain as a rigorous framework in which to classify a patient's asthma control and identify patients at risk for future asthma exacerbations.”
MedWire (www.medwire-news.md) is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2009
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