SELECTED ARTICLES FROM THE RECENT LITERATURE 200512/22/05
Risk factors for acute asthma exacerbations
Summary
Background - Acute asthma exacerbations (AAE) are distressing events markedly affecting the quality of life in patients with persistent asthma (PA). Frequent AAE are considered a sign of poor asthma control. Are there risk factors in individual patients for frequent AAE?Findings - ten Brinke et al of Leiden Univ Medical Center in Holland examined 13 clinical and environmental factors as potential risk factors for frequent AAE in 136 patients with difficult to control asthma. They found that those with at least 3 AAE in the previous year had higher incidence of:
1) severe sinus disease (Odds Ratio, OR=3.7
2) GERD (OR=4.9)
3) recurrent respiratory infections (OR=6.9)
4) psychologic dysfunction (OR=10.8)
5) obstructive sleep apnea (OR=3.4).
All patients with frequent AAE had at least one of these factors, with a 3 factors present in 52% of the frequent AAE group.Reference
Eur Respir J 2005;26:812-8Editor's Comments
These findings, while not terribly surprising, are helpful in that they can be targets for therapeutic intervention and preventive measures. It is only with control of these individual factors that we can determine whether there is a cause and effect relationship with AAE occurrence or whether these statistically significant associations are "true-true but not related". The very strong OR (10.8) for association of psychologic dysfunction with AAE requires further investigation as to whether the psychologic dysfunction is truly independent event or occurs secondary to the morbidity of the PA.
