TY - JOUR
T1 - Predicting episodes of poor asthma control in treated patients with asthma
AU - McCoy, Karen
AU - Shade, David M.
AU - Irvin, Charles G.
AU - Mastronarde, John G.
AU - Hanania, Nicola A.
AU - Castro, Mario
AU - Anthonisen, N. R.
N1 - Funding Information:
The following persons participated in the study: Baylor College of Medicine, Houston, Tex: N. Hanania (principal investigator), P. Enright (coprincipal investigator), M. Sockrider (coprincipal investigator), A. Delgado (principal clinic coordinator for adults), R. McConnell (principal clinic coordinator for children), M. Brock; Children's Hospital at Westchester Medical Center and New York Medical College, Valhalla, NY: A. Dozor (principal investigator), N. Amin (coprincipal investigator), M. Heydendael (principal clinic coordinator), J. Boyer, S. Gjonaj, D. Lowenthal, J. Thorpe (principal clinic nurse); Columbia University–New York University Consortium, New York, NY: P. Rothman (principal investigator), J. Reibman (coprincipal investigator), K. Geromanos (principal clinic coordinator at Columbia University), W. Hoerning (principal clinic coordinator at New York University Consortium), R. Mellins (Columbia University), D. Valacer (Cornell University), G. Turino (Columbia University), C. Cassino (New York University and Columbia University), G. Skloot (Mt Sinai Medical Center), E. Dimango (Columbia University); Duke University Medical Center, Durham, NC: L. Williams (principal investigator), J. Sundy (coprincipal investigator), M. Wilson (principal clinic coordinator); Emory University School of Medicine, Atlanta, Ga: G. Teague (principal investigator), E. Honig (coprincipal investigator), G. Washington (principal clinic coordinator); Illinois Consortium, Chicago, Ill: L. Smith (principal investigator), E. Naureckas (coprincipal investigator), B. Lenhard (principal clinic coordinator), K. Manteuffel, J. Moy, C. S. Olopade, L. Wilkens, S. Reynolds, G. Zagaja; Indiana University, Asthma Clinical Research Center, Indianapolis, Ind: W. Martin II (principal investigator), J. Mastronarde (coprincipal investigator), K. Keller (principal clinic coordinator), J. McMahon, J. Valente; Jefferson Medical College, Philadelphia, Pa: J. Fish (principal investigator), S. Peters (coprincipal investigator), D. Lang (coinvestigator), C. Czajka (principal clinic coordinator), N. Axtman; Louisiana State University Health Sciences Center, Ernest N. Morial Asthma, Allergy, and Respiratory Disease Center, New Orleans, La: D. Thomas (principal investigator), J. Ali (coprincipal investigator), C. Glynn (principal clinic coordinator), E. Fox; National Jewish Medical and Research Center, Denver, Colo: S. Wenzel (principal investigator), P. Silkoff (coprincipal investigator), R. Gibbs (principal clinic coordinator), B. Schoen, C. Ruis, D. Wyatt; Nemours Children's Clinic–University of Florida Consortium, Jacksonville, Fla: J. Lima (principal investigator), K. Blake (coprincipal investigator), L. Duckworth and C. Moore (principal clinic coordinators), J. Cury, D. Schaeffer, F. Livingston; North Shore–Long Island Jewish Health System, New Hyde Park, NY: S. M. Scharf (principal investigator), A. Fein (coprincipal investigator), P. Logalbo, L. Stepner (principal clinic coordinator), G. Malia (principal coordinator for children), D. Mayer, S. Markovics, A. Mensch; Northern New England Consortium (formerly Vermont Lung Center at the University of Vermont), Colchester, Vt: C. G. Irvin (principal investigator), D. A. Kaminsky (coprincipal investigator), M. Lynn (principal clinic coordinator), L. A. Baggott, C. S. Bush, M. DiCello, A. E. Filderman, L. J. Filderman, R. K. Fischer, V. Gardiner, E. M. Harrow, M. Li, C. Mackillop, S. A. Mette, L. M. L. Moon, M. A. Poll, D. Schlichting, P. A. Shapero, K. D. Siegel, E. White-Montor; Ohio State University Children's Hospital, Columbus, Ohio: K. McCoy (principal investigator), J. Jones (coprincipal investigator), M. Johnson (principal clinic coordinator), E. Allen, R. Shell; University of Alabama at Birmingham, Birmingham, Ala: W. C. Bailey (principal investigator), L. B. Gerald (coprincipal investigator), R. Lyrene (investigator), G. A. DuBois (investigator), L. Corley III (investigator), S. Erwin (principal clinic coordinator), B. Martin (clinic coordinator); University of Miami, Miami–University of South Florida, Tampa, Fla: A. Wanner (principal investigator), R. Lockey (principal investigator), A. Brown (principal clinic coordinator for University of Miami), M. Hernandez (principal clinic coordinator for University of South Florida), A. Diecidue, S. Mohapatra, G. Piedimonte; University of Minnesota, Minneapolis, Minn: M. N. Blumenthal (principal investigator), G. Berman (coprincipal investigator) at the Clinical Research Institute, G. Brottman (coprincipal investigator) at Hennepin County Medical Center, J. Parker (coprincipal investigator) at St Mary's Duluth, R. Sveum (coprincipal investigator) at Park Nicollet Medical Center, S. Leikam (principal clinic coordinator) and C. Quintard (clinic coordinator) at the Clinical Research Institute, J. Bertrand (clinic coordinator) at Hennepin County Medical Center, J. Blankush (clinic coordinator) at St Mary's Duluth, L. Rillo (clinic coordinator) at Park Nicollet Medical Center; University of Missouri, Kansas City School of Medicine, Kansas City, Mo: G. Salzman (principal investigator), D. Pyszczynski (coprincipal investigator), J. Portnoy (coprincipal investigator), P. Dowling (coprincipal investigator), S. Schmitz (clinical trial manager), R. Mangold (clinic coordinator), M. Ricklefs (clinic coordinator), D. Horner (clinic coordinator), S. Flack (clinic coordinator); St Louis Asthma Clinical Research Center, Washington University, St Louis University, and Clinical Research Center, St Louis, Mo: M. Castro (principal investigator), M. E. Scheipeter (principal clinic coordinator), B. Becker, E. Fisher, P. Korenblat, R. Slavin, R. Strunk, J. Tillinghast, E. Albers, S. Crocker, S. DeMartino, M. Jenkerson, D. Keaney, L. Robertson, G. Sanders, L. Tegtmeier, D. Turnbow, M. White, and N. Zimmermann (clinic coordinators); Chair's Office, Respiratory Hospital, Winnipeg, Manitoba, Canada: N. Anthonisen (study chair); Data Coordinating Center, Johns Hopkins University Center for Clinical Trials, Baltimore, Md: R. Wise (center director), J. Holbrook (deputy director), C. Levine (principal coordinator), E. Brown, C. Dawson, M. Donithan, C. Meinert, D. Nowakowski, D. Shade, J. Tonascia, X. Wang; Data and Safety Monitoring Board: L. Hudson (chair), V. Chinchilli, P. Lanken, B. McWilliams, C. Rinaldo, D. Tashkin; Project Office, American Lung Association, New York, NY: R. Vento (project officer), G. Pezza, N. Edelman (scientific consultant); Research Coordinating Committee: D. Schraufnagel (chair), M. Iannuzzi (vice-chair), W. Bailey, J. Brown, W.B. Davis, H. DeLisser, F. McCormack, D. Sheppard, A. Wanner, T. Weaver, N. Nedilsky.
PY - 2006/12
Y1 - 2006/12
N2 - 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.
AB - 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.
KW - Asthma exacerbations
KW - asthma control
KW - asthma symptom questionnaires
UR - http://www.scopus.com/inward/record.url?scp=33845224153&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2006.09.006
DO - 10.1016/j.jaci.2006.09.006
M3 - Article
C2 - 17157651
AN - SCOPUS:33845224153
SN - 0091-6749
VL - 118
SP - 1226
EP - 1233
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 6
ER -