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JACI Highlights - June 2006
De Marco et al – Prognostic factors of asthma severity:
a 9-year international prospective cohort study
Asthma severity is a major determinant of morbidity, disability, and the use of health care and social resources. However, its natural history is poorly understood and few studies have been done on the topic. The Global Initiative for Asthma (GINA) guidelines suggest a method to classify asthma severity that relies on three dimensions: perceived symptoms, lung function, and type of anti-asthmatic treatment. In the June 2006 issue of the Journal of Allergy and Clinical Immunology, de Marco and colleagues attempt to contribute to highlighting the natural history of asthma severity using the GINA classification. They found that the deterioration of lung function plays a central role in predicting moderate and severe persistent asthma, whereas symptom control predicts whether asthma is going to remit, to be intermittent or persistent. The presence of persistent cough and mucus hypersecretion, and of elevated levels of total immunoglobulin E are strong prognostic factors for moderate and severe asthma, and asthma remission is rarely observed in people with poor lung function or a high level of symptoms in the past. De Marco et al found that weight loss or minimal weight gain is significantly associated with asthma remission. The present study has shown that moderate and severe asthmatics are characterized by an early airflow limitation, and that they show a common pattern of prognostic factors. Remission in asthma mainly occurs in patients with milder asthma and is rarely observed among people with poor lung function. The knowledge of the prognostic factors and of the natural history of asthma severity could help doctors in better managing and monitoring their patients.
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