Trigger avoidance may reduce asthma exacerbations and improve quality of life

Published Online: July 8, 2014

Asthma is associated with high costs. These costs increase if patients suffer uncontrolled asthma1. When asthma is not well controlled, worsening of symptoms or an asthma exacerbation may occur, and patients tend to visit the doctor and the emergency department (ED) more frequently. They may also be more likely to require hospitalization. Triggers of asthma exacerbations include respiratory infections, allergens, irritants, exercise, and emotions.

Between 2001 and 2004, a large study—The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR)—collected clinical and patient-reported outcome information from patients with severe or difficult-to-treat asthma2. In a study recently published in The Journal of Allergy and Clinical Immunology: In Practice, Luskin and colleagues used data from TENOR to examine: 1) the relationship between the number and severity of asthma exacerbations and asthma-related quality of life (QoL), 2) the relationship between asthma triggers and QoL, and 3) the association between asthma triggers and both the number and severity of asthma exacerbations. Data from patients who were at least 13 years old were included in the analysis. Information reviewed included hospitalizations, ED visits, short courses of oral corticosteroids, QoL (as measured by the validated Mini-Asthma Quality of Life Questionnaire), and number and type of asthma triggers.

Approximately 2,700 patients were included in the analysis. The study showed that patients’ QoL decreased with the increasing severity of asthma exacerbations (increasing order of severity: no exacerbation, short course of oral corticosteroid, ED visit, and hospitalization). Patient QoL also decreased with the increasing number of asthma exacerbations. Patients with more asthma triggers had more frequent and severe asthma exacerbations, and reported a correspondingly lower QoL. Cold/sinus infection, emotional stress, and mold/dampness were most strongly predictive of a future asthma exacerbation, and emotional stress, dust, mold/dampness, and pollen were identified as triggers that were strongly associated with poorer QoL.

This analysis by Luskin and colleagues is the first large observational study to report the inter-relationships between asthma exacerbations, asthma triggers, and QoL. The results support the need for patients to avoid asthma triggers in order to reduce the risk of an asthma exacerbation and, ultimately, improve asthma-related QoL.

1. Global Initiative for Asthma. GINA report, global strategy for asthma management and prevention. Accessed March 26, 2014.
2. Dolan CM, Fraher KE, Bleecker ER, et al.; TENOR Study Group. Design and baseline characteristics of The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma. Ann Allergy Asthma Immunol. 2004; 92(1):32-39.

The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.

AAAAI - American Academy of Allergy Asthma & Immunology