Predicting which asthma patients will have exacerbations and worse symptoms
Published Online: July 25, 2014
Assessment of the future risk of adverse outcomes in asthma patients is an important component in identifying high-risk patients and guiding clinical management. However, there are few data to guide clinicians as to which, if any, patient characteristics might predict marked reliever inhaler overuse in the future.
In their study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Patel and colleagues investigated factors that could predict future adverse outcomes in adult asthmatics. Data were taken from a randomized controlled trial involving 303 adult asthma patients who received a single budesonide/formoterol inhaler as maintenance and reliever therapy (SMART regimen), or a budesonide/formoterol inhaler as maintenance therapy with salbutamol as reliever (‘Standard’). Multivariable analyses were used to evaluate the relationships between patient baseline characteristics and the likelihood of an exacerbation of asthma, poor symptom control (based on the Asthma Control Questionnaire, ACQ), and episodes of marked reliever inhaler overuse in the future.
Reduced lung function, previous severe exacerbations, Standard management (as compared to the SMART regimen), and female gender predicted risk of severe exacerbation. Baseline control (ACQ-5) and older age predicted future poorly controlled asthma. Higher self-reported reliever inhaler use, Māori ethnicity, and reduced lung function were predictors of episodes of marked reliever inhaler overuse in the future.
Future severe asthma exacerbations, poor asthma control, and episodes of marked reliever inhaler overuse can be predicted in the clinical setting through the assessment of different baseline clinical and demographic characteristics.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.