Asthma and lower airway disease
Recent asthma exacerbations predict future exacerbations in children with severe or difficult-to-treat asthma

https://doi.org/10.1016/j.jaci.2009.09.006Get rights and content

Background

Children with severe/difficult-to-treat asthma experience high morbidity including frequent severe exacerbations. More knowledge is required to identify predictors of these exacerbations to reduce their occurrence.

Objective

To investigate the risk of future severe exacerbations (FSEs) in children with severe/difficult-to-treat asthma and recent severe exacerbations (RSEs).

Methods

We analyzed the occurrence and association of RSE (defined as 1 or more corticosteroid bursts during the 3 months before each of 3 annual visits) and FSE (defined as 1 or more corticosteroid bursts 6 or 12 months later) in children age 6 to 11 years in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens 3-year observational study. Repeated measures logistic regression analysis assessed the risk of FSE adjusted for demographics and clinical variables.

Results

In a multivariable model, FSE at 6 months was most strongly predicted by RSE (odds ratio [OR], 3.08; 95% CI, 2.21-4.28) and having 3 to 4 allergic triggers (OR, 2.05; 95% CI, 1.31-3.20). Race (OR, 1.77; 95% CI, 1.25-2.51) and being very poorly controlled according to the impairment component of the National Heart, Lung, and Blood Institute guidelines (OR, 1.59; 95% CI, 1.14-2.23) also significantly predicted FSE.

Conclusion

Recent severe asthma exacerbations are an important independent predictor of FSE in children with severe/difficult-to-treat asthma and should be considered when establishing asthma management plans.

Section snippets

Study design

The methods and baseline cohort characteristics of the TENOR study have been previously described.8, 15 Briefly, TENOR was a prospective, observational, 3-year study (2001-2004) conducted in the United States in patients with severe difficult-to-treat asthma followed by asthma specialists. Patients were recruited from diverse geographic areas to represent typical patient care settings, including managed care organizations, community physicians/practices, and academic centers. No experimental

Baseline demographics and RSE

Of the 637 children age 6 to 11 years in the TENOR database, 68 did not have any follow-up data, and 6 others did not have follow-up visits during which HCU data were recorded, leaving data from 563 children available for analysis. Children excluded from the analysis were not appreciably different from those included in terms of age, physician-assessed asthma severity, and number of asthma control problems, but they were more likely to be girls (44.4% vs 31.3%; P = .025) and black (35.1% vs

Discussion

This study demonstrates a strong association between recent and future severe exacerbations in a large cohort of children with severe or difficult-to-treat asthma. This association persisted and remained strong (ORs ranged from 1.99 to 3.08) after adjusting for demographic and clinical variables, asthma control by the impairment domain, and allergic and nonallergic triggers, demonstrating that regardless of these other factors, RSE is the main driver of FSE in children with severe or

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  • Cited by (0)

    Support for third-party medical writing assistance was provided by Genentech USA, Inc, and Novartis Pharmaceuticals Corp.

    Disclosure of potential conflict of interest: T. Haselkorn is a consultant for Genentech. R. S. Zeiger is a consultant for Aerocrine, AstraZeneca, Dynavax, Genentech, GlaxoSmithKline, Merck, Novartis, and Schering-Plough and has received research support from AstraZeneca, Merck, GlaxoSmithKline, TEVA, Aerocrine, and the National Heart, Lung, and Blood Institute. B. E. Chipps is an advisor and/or speakers' bureau member for Alcon, Aventis, Genentech, AstraZeneca, Boehringer, GlaxoSmithKline, MedPoint, Novartis, Pfizer, Schering, Sepracor, and Merck and has received support for research and/or educational activities from Alcon, Aventis, Genentech, AstraZeneca, GlaxoSmithKline, MedPoint, Novartis, Schering, Sepracor, and Merck. D. R. Mink is an employee of ICON Clinical Research, which receives research funding from Genentech. S. J. Szefler is a consultant for GlaxoSmithKline, Genentech, and Merck and has received research support from the National Institutes of Health, the National Heart, Lung, and Blood Institute, the National Institute of Allergy and Infectious Diseases, Ross Pharmaceuticals, and GlaxoSmithKline. F. E. R. Simons has received research support from the Canadian Institutes of Health Research and has consulted for Genentech. M. Massanari is an employee of Novartis. J. E. Fish is an employee of Genentech.

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