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

Beasley, Richard; Weatherall, Mark; Black, P.; Shaw, D.; Tranquilino, T.; Mackey, B.; Qi, V.; Reddel, H.K.; Pilcher, J.; Patel, M.; Pilcher, Janine; Reddel, Helen K.; Qi, Victoria; Mackey, Bill; Tranquilino, Tyronne; Shaw, Dominick; Black, Peter

Authors

Richard Beasley

Mark Weatherall

P. Black

D. Shaw

T. Tranquilino

B. Mackey

V. Qi

H.K. Reddel

J. Pilcher

M. Patel

Janine Pilcher

Helen K. Reddel

Victoria Qi

Bill Mackey

Tyronne Tranquilino

Peter Black



Abstract

Background:
Predictors of asthma exacerbations, poor asthma control, or extreme β-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” β-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), Māori 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 β-agonist overuse.

Conclusion:
Future severe asthma exacerbations, poor asthma control, and extreme β-agonist overuse are predicted by different baseline clinical and demographic characteristics and management approaches in at-risk asthma.

Citation

Beasley, R., Weatherall, M., Black, P., Shaw, D., Tranquilino, T., Mackey, B., …Black, P. (2014). Predictors of Severe Exacerbations, Poor Asthma Control, and β-Agonist Overuse for Patients with Asthma. Journal of Allergy and Clinical Immunology: In Practice, 2(6), 751-758.e1. https://doi.org/10.1016/j.jaip.2014.06.001

Journal Article Type Article
Acceptance Date Jun 9, 2014
Online Publication Date Jul 25, 2014
Publication Date 2014-11
Deposit Date May 11, 2017
Publicly Available Date
Journal The Journal of Allergy and Clinical Immunology: In Practice
Print ISSN 2213-2198
Electronic ISSN 2213-2201
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 2
Issue 6
Pages 751-758.e1
DOI https://doi.org/10.1016/j.jaip.2014.06.001
Keywords Asthma; β-agonist; Electronic monitoring; Predictors; Risk
Public URL http://eprints.nottingham.ac.uk/id/eprint/42776
Publisher URL http://www.sciencedirect.com/science/article/pii/S2213219814002323