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Swarnakar R, Dhar R. Call to action: Addressing asthma diagnosis and treatment gaps in India. Lung India 2024; 41:209-216. [PMID: 38687232 PMCID: PMC11093140 DOI: 10.4103/lungindia.lungindia_518_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 12/22/2023] [Accepted: 12/31/2023] [Indexed: 05/02/2024] Open
Abstract
In comparison to the worldwide burden of asthma, although India contributes to 13% of the total asthma prevalence, it has a threefold higher mortality rate and more than twofold higher DALYs, indicating a substantial gap in asthma diagnosis and treatment. Asthma causes significant suffering, affecting people's quality of life and draining the country's resources; therefore, we must devise ways and means to fill these gaps. The most successful and cost-efficient strategy to battle asthma is to form strong partnerships between patients, the general public, the government, the pharmaceutical industry and non-governmental organisations. This necessitates a comprehensive approach that involves raising awareness, developing universally applicable recommendations, increasing access to high-quality asthma care, and other measures. The purpose of this article was to review the existing scenario of asthma management in India and the factors that contribute to it and devise unique and all-encompassing strategies to fill these gaps.
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Affiliation(s)
- Rajesh Swarnakar
- Department of Pulmonology, Getwell Hospital and Research Institute, Nagpur, Maharashtra, India
| | - Raja Dhar
- Department of Pulmonary, Sleep and Critical Care Medicine, Calcutta Medical Research Institute and Hospital, Kolkata, West Bengal, India
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Azmeh R, Greydanus DE, Agana MG, Dickson CA, Patel DR, Ischander MM, Lloyd RD. Update in Pediatric Asthma: Selected Issues. Dis Mon 2019; 66:100886. [PMID: 31570159 DOI: 10.1016/j.disamonth.2019.100886] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Asthma is a complex condition that affects 14% of the world's children and the approach to management includes both pharmacologic as well as non-pharmacologic strategies including attention to complex socioeconomic status phenomena. After an historical consideration of asthma, allergic and immunologic aspects of asthma in children and adolescents are presented. Concepts of socioeconomic aspects of asthma are considered along with environmental features and complications of asthma disparities. Also reviewed are links of asthma with mental health disorders, sleep disturbances and other comorbidities. A stepwise approach to asthma management is discussed that includes pharmacologic and non-pharmacologic strategies in the pediatric population. The role of immunotherapy and use of various immunomodulators are considered as well.
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Affiliation(s)
- Roua Azmeh
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Donald E Greydanus
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States.
| | - Marisha G Agana
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Cheryl A Dickson
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States; Health Equity and Community Affairs, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, Michigan, United States
| | - Dilip R Patel
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Mariam M Ischander
- Department of Pediatric and Adolescent Medicine, Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, United States
| | - Robert D Lloyd
- Pacific Northwest University of Health Sciences College of Osteopathic Medicine, Yakima, Washington, United States
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Buelo A, McLean S, Julious S, Flores-Kim J, Bush A, Henderson J, Paton JY, Sheikh A, Shields M, Pinnock H. At-risk children with asthma (ARC): a systematic review. Thorax 2018; 73:813-824. [PMID: 29871982 PMCID: PMC6109248 DOI: 10.1136/thoraxjnl-2017-210939] [Citation(s) in RCA: 63] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Revised: 04/12/2018] [Accepted: 04/16/2018] [Indexed: 01/15/2023]
Abstract
Introduction Asthma attacks are responsible for considerable morbidity and may be fatal. We aimed to identify and weight risk factors for asthma attacks in children (5–12 years) in order to inform and prioritise care. Methods We systematically searched six databases (May 2016; updated with forward citations January 2017) with no language/date restrictions. Two reviewers independently selected studies for inclusion, assessed study quality and extracted data. Heterogeneity precluded meta-analysis. Weighting was undertaken by an Expert Panel who independently assessed each variable for degree of risk and confidence in the assessment (based on study quality and size, effect sizes, biological plausibility and consistency of results) and then achieved consensus by discussion. Assessments were finally presented, discussed and agreed at a multidisciplinary workshop. Results From 16 109 records, we included 68 papers (28 cohort; 4 case-control; 36 cross-sectional studies). Previous asthma attacks were associated with greatly increased risk of attack (ORs between 2.0 and 4.1). Persistent symptoms (ORs between 1.4 and 7.8) and poor access to care (ORs between 1.2 and 2.3) were associated with moderately/greatly increased risk. A moderately increased risk was associated with suboptimal drug regimen, comorbid atopic/allergic disease, African-American ethnicity (USA), poverty and vitamin D deficiency. Environmental tobacco smoke exposure, younger age, obesity and low parental education were associated with slightly increased risk. Discussion Assessment of the clinical and demographic features identified in this review may help clinicians to focus risk reduction management on the high-risk child. Population level factors may be used by health service planners and policymakers to target healthcare initiatives. Trial registration number CRD42016037464.
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Affiliation(s)
- Audrey Buelo
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Susannah McLean
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Steven Julious
- Medical Statistics Group, ScHARR, University of Sheffield, Sheffield, UK
| | - Javier Flores-Kim
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Andy Bush
- Department of Paediatric Respiratory Medicine, Imperial College and Royal Brompton Hospital, London, UK
| | - John Henderson
- Department of Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - James Y Paton
- School of Medicine, College of Medical, Veterinary, and Life Sciences, University of Glasgow, Glasgow, UK
| | - Aziz Sheikh
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
| | - Michael Shields
- Centre for Experimental Medicine, Queen's University, Belfast, UK
| | - Hilary Pinnock
- Asthma UK Centre for Applied Research, Usher Institute of Population Health Sciences and Informatics, The University of Edinburgh, Edinburgh, UK
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Abstract
BACKGROUND Recent studies reported that infection by varicella zoster virus (VZV) may lead to delayed onset of asthma in children/adolescents. This information will likely alter the cost-effectiveness of the US. VZV vaccination program. We created a decision analysis model to estimate the costs and health-related effects of VZV 2-dose vaccination, assuming VZV infection delays asthma onset. METHODS The Markov model considered a birth cohort of 3,957,577 individuals entering the population from a societal perspective. We predicted the number of asthma/VZV cases, asthma-/VZV-related mortality and costs associated with asthma/VZV. Comparison arms included (1) VZV vaccination program without delayed asthma onset, (2) VZV vaccination program with delayed asthma onset and (3) no VZV vaccination program with delayed asthma onset. We considered delayed onset ranging from 3 to 12 years. RESULTS The vaccination program proved cost-effective without an assumed delay in asthma onset. When the vaccination and no-vaccination arms were compared assuming delayed asthma onset, vaccination remained less costly despite increased savings related to asthma without vaccination. With delayed asthma onset of 9 years post VZV infection, cost savings due to vaccination were $914.09 million, with 9984 cases of asthma averted and 9 greater overall deaths with vaccination. CONCLUSION VZV vaccination program was less costly than the "no-vaccination" scenario, despite delayed onset of asthma post VZV infection. However, vaccination resulted in increased asthma morbidity and mortality. This adds to current evidence that VZV vaccination is cost-effective, and may alter asthma-related health-care outcomes. VZV's effect on asthma symptoms still needs further evaluation before firm conclusions can be reached.
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Scott L, Li M, Thobani S, Nichols B, Morphew T, Kwong KYC. Asthma control and need for future asthma controller therapy among inner-city Hispanic asthmatic children engaged in a pediatric asthma disease management program (the Breathmobile program, Mobile Asthma Care for Kids Network). J Asthma 2016; 53:629-34. [PMID: 27221537 DOI: 10.3109/02770903.2015.1050498] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To determine whether significant numbers of asthmatic children with initially rated intermittent asthma later suffer poor asthma control and require the addition of controller medications. METHODS Inner-city Hispanic children were followed prospectively in an asthma-specific disease management system (Breathmobile) for a period of 2 years. Clinical asthma symptoms, morbidity treatment, and demographic data were collected at each visit. Treatment was based upon National Heart, Lung, and Blood Institute (NHLBI) Expert Panel Report 3 asthma guidelines. Primary outcome was percentage of patients with intermittent asthma who had not well or poorly controlled asthma during subsequent visits and required controller agents. Secondary outcomes were factors associated with the maintenance of asthma control. RESULTS About 30.9% of the patients with initial rating of intermittent asthma had not well controlled and poorly controlled asthma during subsequent visits and required the addition of controller agents. Factors associated with good asthma control were compliance, no previous emergency room visits and previous visit during spring season. CONCLUSION Asthmatic children with intermittent asthma often lose asthma control and require controller therapy. This justifies asthma guideline recommendations to assess asthma control at follow-up visits and adjust therapy accordingly.
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Affiliation(s)
- Lyne Scott
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
| | - Marilyn Li
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
| | - Salima Thobani
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
| | - Breck Nichols
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
| | - Tricia Morphew
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
| | - Kenny Yat-Choi Kwong
- a Department of Pediatrics , Division of Allergy-Immunology , Los Angeles County + University of Southern California Medical Center , Los Angeles , CA, USA
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Abstract
The inner city has long been recognized as an area of high asthma morbidity and mortality. A wide range of factors interact to create this environment. These factors include well-recognized asthma risk factors that are not specific to the inner city, the structure and delivery of health care, the location and function of the urban environment, and social inequities. In this article, these facets are reviewed, and successful and unsuccessful interventions are discussed, to understand what is needed to solve this problem.
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Affiliation(s)
- Peter J Gergen
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA.
| | - Alkis Togias
- Allergy, Asthma, Airway Biology Branch (AAABB), MD, USA
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Abstract
PURPOSE OF REVIEW One strategy to improve asthma control is to identify risk factors for uncontrolled asthma in epidemiologic studies and then consider those risk factors as potential targets for intervention. This article reviews predictors of impairment based on validated tools and predictors of severe asthma exacerbations. RECENT FINDINGS Indirectly modifiable risk factors for poor asthma control include older age in adults, lower socioeconomic status, and poor perception of dyspnea. Modifiable risk factors for poor asthma control include allergy triggers, low adherence, comorbidities, absence of specialty care, and various aspects of asthma self-management education. SUMMARY Intervention strategies are suggested for predictors that are directly or indirectly modifiable. It is hoped that attention to these factors will improve asthma control and reduce the burden of disease.
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Abstract
PURPOSE OF REVIEW Guidelines suggest that asthma medication should be reduced once asthma control is sustained. Moderate-dose inhaled corticosteroids (ICS) can typically be reduced, but questions remain about the lowest effective ICS dose and the role of non-ICS controllers in treatment reduction. Long-acting beta agonist (LABA) safety concerns have created controversy about how to step down patients on ICS/LABA therapy. This review will focus on the current status of these issues. RECENT FINDINGS Intermittent ICS treatment, often in fixed combination with short-acting beta agonist, is an emerging strategy for control of mild asthma. Addition of leukotriene modifiers, LABAs, and omalizumab to ICS can allow for reduced ICS dosing. Doses of ICS that control symptoms may be inadequate to control exacerbations. Reducing ICS dose before discontinuing LABAs may be the more effective approach for patients on combination therapy. SUMMARY Use of non-ICS controllers allows for ICS dose reduction with superior outcomes. Tapering of ICS prior to LABA discontinuation may be the favored approach for patients on ICS/LABA therapy, but an understanding of long-term outcomes and further safety data are required. The lowest ICS dose that adequately controls both asthma impairment and risk remains to be determined.
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Scott L, Morphew T, Bollinger ME, Samuelson S, Galant S, Clement L, O'Cull K, Jones F, Jones CA. Achieving and maintaining asthma control in inner-city children. J Allergy Clin Immunol 2011; 128:56-63. [PMID: 21531451 DOI: 10.1016/j.jaci.2011.03.020] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2010] [Revised: 03/17/2011] [Accepted: 03/18/2011] [Indexed: 12/14/2022]
Abstract
BACKGROUND Despite guidelines-defined care, inner-city children of low socioeconomic status have poor asthma control. OBJECTIVE This study evaluated time to achieve control, maintenance of control, and factors associated with well controlled asthma for pediatric patients receiving specialty-based asthma care in mobile asthma clinics designed to reduce barriers to delivering effective asthma care (the Breathmobile Program). METHODS Existing clinical data collected from January 1998 to June 2008 for 7822 pediatric patients with asthma (34,339 visits) enrolled in similarly structured mobile asthma programs across the United States evaluated the effect of asthma control on the reduction of asthma-related morbidity, time to achieve asthma control, maintenance of asthma control, and factors associated with well controlled asthma. RESULTS Comparison of pre and post year data for subjects enrolled in the program for at least 1 year revealed reductions in the percentage of patients reporting emergency department visits (mean, 66%), hospitalizations (mean, 84%), and missed school days ≥5/year (mean, 78%). Well controlled asthma was achieved by visit 3 for an estimated 80% of patients. Factors contributing to well controlled asthma include non-African American race, visit interval <90 days, and adherence to prescribed therapy. CONCLUSION This study demonstrates the ability to achieve and maintain asthma control in high-risk populations in association with intensive, accessible, guidelines-defined care with close follow-up.
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Affiliation(s)
- Lyne Scott
- Los Angeles County + University of Southern California Medical Center, Los Angeles, CA, USA.
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The exacerbation component of impairment and risk in pediatric asthma. Curr Opin Allergy Clin Immunol 2010; 10:155-60. [PMID: 20010093 DOI: 10.1097/aci.0b013e328335ce60] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The new guidelines for assessment of asthma control emphasize two domains: impairment and risk. Exacerbations of asthma are an important component of risk but have not received as much attention as the day-to-day symptoms that make up impairment. The purpose of this review is to report what has recently been learned about exacerbations. RECENT FINDINGS Exacerbations occur in the context of both controlled and uncontrolled asthma. Exacerbations are a strong independent risk factor of further exacerbations. This suggests that unrecognized factors may be involved in susceptibility to exacerbations in addition to more commonly recognized triggers such as viruses, allergens, and poorly controlled asthma. Such factors may be the result of genetic variation. Recent evidence now shows a residual effect on lung function from an exacerbation event. There are no current specific intervention measures to prevent exacerbations but attention to management practices continues to look at the role of the emergency department in improving care. SUMMARY The presence of exacerbations is considered a risk factor of the likelihood of further exacerbations and requires assessment of the triggers identified with history of exacerbations, host factors, atopic disposition, exposure to allergens, adherence to prescribed medications, and preventive measures to reduce future risk of such an event.
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Huynh P, Salam MT, Morphew T, Kwong KYC, Scott L. Residential Proximity to Freeways is Associated with Uncontrolled Asthma in Inner-City Hispanic Children and Adolescents. J Allergy (Cairo) 2010; 2010:157249. [PMID: 20948882 PMCID: PMC2948442 DOI: 10.1155/2010/157249] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 03/24/2010] [Indexed: 11/18/2022] Open
Abstract
Background. Proximity to heavy traffic has been linked to increased asthma severity. However, it is unknown whether exposure to heavy traffic is associated with the ability to maintain asthma control. Objectives. This study examines whether exposure to heavy traffic is associated with the ability to maintain asthma control in inner-city children. Methods. 756 inner-city asthmatic Hispanic children were followed for one year in a pediatric asthma management program (Breathmobile). At each scheduled visit, asthma specialist tracked patients' asthma severity and managed their asthma based on the NAEPP guidelines. The patients' residential distance from the nearest freeway was calculated based on residential address at study entry. Distance to nearest freeway was used as a surrogate marker for high exposure from traffic-related air pollutants. Results. Patients who lived near a freeway were significantly more likely to have asthma that was not well controlled (P = .03). Patients with intermittent and mild baseline severity have a two-fold increased risk of having asthma that is uncontrolled if they lived <2 miles from a freeway (OR = 2.2, P = .04). Conclusion. In children with asthma, residential proximity to freeways is associated with uncontrolled asthma.
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Affiliation(s)
- Peter Huynh
- Division of Allergy and Immunology, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Muhammad T. Salam
- Department of Preventive Medicine, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
| | - Tricia Morphew
- Southern California Chapter, Asthma and Allergy Foundation of America, Los Angeles, CA 90036, USA
| | - Kenny Y. C. Kwong
- Division of Allergy-Immunology, Department of Pediatrics, Harbor-UCLA Medical Center, University of California, Los Angeles, CA 90095, USA
| | - Lyne Scott
- Division of Allergy and Immunology, Department of Pediatrics, Los Angeles County and University of Southern California Medical Center, University of Southern California Keck School of Medicine, Los Angeles, CA 90033, USA
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Huynh PN, Scott LG, Kwong KYC. Long-term maintenance of pediatric asthma: focus on budesonide/formoterol inhalation aerosol. Ther Clin Risk Manag 2010; 6:65-75. [PMID: 20234786 PMCID: PMC2835561 DOI: 10.2147/tcrm.s4025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2010] [Indexed: 11/25/2022] Open
Abstract
Current national and international asthma guidelines recommend treatment of children with asthma towards achieving and maintaining asthma control. These guidelines provide more stringent recommendations to increase therapy for patients with uncontrolled asthma in order to reduce asthma-related morbidity and mortality. Newer combination agents such as budesonide and formoterol have been shown to be safe and effective in treatment of asthma in children. Use of long-term controller agents like this in combination with improved compliance and treatment of co-morbid conditions have been successful in this endeavor. This review discusses control of pediatric asthma with focus on the use of budesonide in combination with formoterol.
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Affiliation(s)
- Peter N Huynh
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, USA
| | - Lyne G Scott
- Division of Allergy-Immunology, Department of Pediatrics, Los Angeles County, University of Southern California Medical Center, Los Angeles, CA, USA
| | - Kenny YC Kwong
- Division of Allergy-Immunology, Department of Pediatrics, Harbor-UCLA Medical Center, Torrance, CA, USA
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Haselkorn T, Zeiger RS, Chipps BE, Mink DR, Szefler SJ, R. Simons FE, Massanari M, Fish JE. Recent asthma exacerbations predict future exacerbations in children with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2009; 124:921-7. [DOI: 10.1016/j.jaci.2009.09.006] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2009] [Revised: 08/22/2009] [Accepted: 09/03/2009] [Indexed: 10/20/2022]
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Gruchalla RS, Sampson HA, Matsui E, David G, Gergen PJ, Calatroni A, Brown M, Liu AH, Bloomberg GR, Chmiel JF, Kumar R, Lamm C, Smartt E, Sorkness CA, Steinbach SF, Stone KD, Szefler SJ, Busse WW. Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: role of predictors in the setting of high adherence. J Allergy Clin Immunol 2009; 124:213-21, 221.e1. [PMID: 19615730 DOI: 10.1016/j.jaci.2009.05.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2008] [Revised: 04/21/2009] [Accepted: 05/26/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND With the expanding effort to provide guidelines-based therapy to adolescents with asthma, attention must be directed to evaluating which factors predict future asthma control when guidelines-based management is applied. OBJECTIVE We evaluated the role of fraction of exhaled nitric oxide in parts per billion, markers of allergic sensitization, airway inflammation, and measures of asthma severity in determining future risk of asthma symptoms and exacerbations in adolescents and young adults participating in the Asthma Control Evaluation study. METHODS Five hundred forty-six inner-city residents, ages 12 through 20 years, with persistent asthma were extensively evaluated at study entry for predictors of future symptoms and exacerbations over the subsequent 46 weeks, during which guidelines-based, optimal asthma management was offered. Baseline measurements included fraction of exhaled nitric oxide in parts per billion, total IgE, allergen-specific IgE, allergen skin test reactivity, asthma symptoms, lung function, peripheral blood eosinophils, and, for a subset, airway hyperresponsiveness and sputum eosinophils. RESULTS The baseline characteristics we examined accounted for only a small portion of the variance for future maximum symptom days and exacerbations--11.4% and 12.6%, respectively. Future exacerbations were somewhat predicted by asthma symptoms, albuterol use, previous exacerbations, and lung function, whereas maximum symptom days were predicted, also to a modest extent, by symptoms, albuterol use, and previous exacerbations, but not lung function. CONCLUSION Our findings demonstrate that the usual predictors of future disease activity have little predictive power when applied to a highly adherent population with persistent asthma that is receiving guidelines-based care. Thus, new predictors need to be identified that will be able to measure the continued fluctuation of disease that persists in highly adherent, well-treated populations such as the one studied.
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Affiliation(s)
- Rebecca S Gruchalla
- University of Texas Southwestern Medical Center, Dallas, Tex 75390-8859, USA.
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