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

Tmirah Haselkorn, James E. Fish, Robert S. Zeiger, Stanley J. Szefler, Dave P. Miller, Bradley E. Chipps, F. Estelle R. Simons, Scott T. Weiss, Sally E. Wenzel, Larry Borish, Eugene R. Bleecker

Research output: Contribution to journalArticlepeer-review

152 Scopus citations

Abstract

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.

Original languageEnglish (US)
Pages (from-to)895-902.e4
JournalJournal of Allergy and Clinical Immunology
Volume124
Issue number5
DOIs
StatePublished - Nov 2009
Externally publishedYes

Keywords

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

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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