TY - JOUR
T1 - Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents
AU - Pongracic, Jacqueline A.
AU - Krouse, Rebecca Z.
AU - Babineau, Denise C.
AU - Zoratti, Edward M.
AU - Cohen, Robyn T.
AU - Wood, Robert A.
AU - Khurana Hershey, Gurjit K.
AU - Kercsmar, Carolyn M.
AU - Gruchalla, Rebecca S.
AU - Kattan, Meyer
AU - Teach, Stephen J.
AU - Johnson, Christine C.
AU - Bacharier, Leonard B.
AU - Gern, James E.
AU - Sigelman, Steven M.
AU - Gergen, Peter J.
AU - Togias, Alkis
AU - Visness, Cynthia M.
AU - Busse, William W.
AU - Liu, Andrew H.
N1 - Funding Information:
This project has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Department of Health and Human Services (under contract nos. HHSN272200900052C and HHSN272201000052I, and 1UM1AI114271-01). Additional support was provided by the National Center for Research Resources (NCRR), and the National Center for Advancing Translational Sciences (NCATS), NIH (under grant nos. NCRR/NIH UL1TR000451, UL1RR025780, UL1TR000075 Q1 and NCATS/NIH UL1TR000154, UL1TR001082, UL1TR000077-04, UL1TR000040, UL1TR000150, and UL1TR001105). GlaxoSmithKline (GSK) provided Ventolin, Flovent, Advair, and Flonase under a clinical trial agreement with NIH NIAID; GSK did not have a role in the development or approval of the protocol, conduct of the trial, data analysis, manuscript preparation, or the decision to submit the manuscript for publication.
Publisher Copyright:
© 2016 American Academy of Allergy, Asthma & Immunology
PY - 2016/10/1
Y1 - 2016/10/1
N2 - Background Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. Objective We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma. Methods Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models. Results Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV1 bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy. Conclusions Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.
AB - Background Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. Objective We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma. Methods Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models. Results Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV1 bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy. Conclusions Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.
KW - Child
KW - IgE
KW - allergen sensitization
KW - asthma
KW - asthma exacerbations
KW - asthma morbidity
KW - asthma phenotype
KW - asthma severity
KW - inner-city asthma
KW - pulmonary function
KW - rhinitis
UR - http://www.scopus.com/inward/record.url?scp=84992206932&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2016.06.059
DO - 10.1016/j.jaci.2016.06.059
M3 - Article
C2 - 27720017
AN - SCOPUS:84992206932
SN - 0091-6749
VL - 138
SP - 1030
EP - 1041
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 4
ER -