Predictors of Severe Exacerbations, Poor Asthma Control, and β-Agonist Overuse for Patients with Asthma

被引：54

作者：

Patel, Mitesh ^{[1
,2
,3
]}

Pilcher, Janine ^{[1
,2
]}

Reddel, Helen K. ^{[4
]}

Qi, Victoria ^{[5
]}

Mackey, Bill ^{[5
]}

Tranquilino, Tyronne ^{[5
]}

Shaw, Dominick ^{[3
]}

Black, Peter ^{[6
]}

Weatherall, Mark ^{[2
,7
]}

Beasley, Richard ^{[1
,2
,7
]}

机构：

[1] Med Res Inst New Zealand, Wellington, New Zealand

[2] Capital & Coast Dist Hlth Board, Wellington, New Zealand

[3] Univ Nottingham, Sch Clin Sci, Div Resp Med, Nottingham NG7 2RD, England

[4] Univ Sydney, Woolcock Inst Med Res, Clin Management Grp, Sydney, NSW 2006, Australia

[5] Henderson Med Ctr, Auckland, New Zealand

[6] Univ Auckland, Pharmacol & Clin Pharmacol, Auckland 1, New Zealand

[7] Univ Otago, Sch Med, Wellington, New Zealand

来源：

JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE | 2014年 / 2卷 / 06期

关键词：

Asthma; beta-agonist; Electronic monitoring; Predictors; Risk; TREATMENT REGIMENS TENOR; CONTROL QUESTIONNAIRE; RELIEVER MEDICATION; NATURAL-HISTORY; PREVALENCE; RISK; COMBINATION; FORMOTEROL; INHALER; HEALTH;

D O I：

10.1016/j.jaip.2014.06.001

中图分类号：

R392 [医学免疫学];

学科分类号：

100102 ;

摘要：

BACKGROUND: Predictors of asthma exacerbations, poor asthma control, or extreme beta-agonist overuse may be of clinical utility in the management of asthma. OBJECTIVE: To investigate characteristics that predict subsequent adverse outcomes in asthma. METHODS: An independent 24-week, randomized controlled trial of 303 adult patients with asthma who are at risk, which compared the efficacy of SMART (single budesonide-formoterol inhaler as maintenance and reliever therapy) with a fixed-dose regimen with salbutamol as reliever ("Standard"). Inhaled medication use was measured by electronic monitoring. Baseline characteristics that were predictors of subsequent severe asthma exacerbations, poor asthma control (Asthma Control Questionnaire -5 score >= 1.5), and "extreme" beta-agonist overuse (>16 budesonide-formoterol actuations/d in SMART and >32 salbutamol actuations/d in Standard) were assessed by multivariate analyses. RESULTS: FEV1 % predicted (rate ratio [RR] 1.14 [95% CI, 1.03-1.27] per 10% lower), more previous exacerbations (RR 1.15 [95% CI, 1.01-1.31]), Standard therapy (RR 1.62 [95% CI, 1.07-2.47]), and female sex (RR 2.18 [95% CI, 1.29-3.67]) were associated with future severe exacerbations. Asthma Control Questionnaire-5 (regression coefficient 0.20 [95% CI, 0.13-0.27] per 0.5 points higher) and age (regression coefficient 0.09 [95% CI, 0.01-0.17] per decade older) were associated with future poorly controlled asthma. Higher reliever use (RR 1.63 [95% CI, 1.36-1.95] per categorical score in Asthma Control Questionnaire question no. 6), Maori ethnicity (RR 2.20 [95% CI, 1.43-3.38]) and FEV1 % predicted (RR 1.16 [95% CI, 1.03-1.31] per 10% lower) were associated with future extreme beta-agonist overuse. CONCLUSION: Future severe asthma exacerbations, poor asthma control, and extreme b-agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma. (C) 2014 American Academy of Allergy, Asthma & Immunology

引用

页码：751 / +

页数：9

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