Current asthma control predicts future risk of asthma exacerbation: a 12-month prospective cohort study

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Author:
WEI Hua-hua(Department of Respiratory and Critical Care Medicine,Pneumology Group,,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
ZHOU Ting(Department of Integrated Traditional Chinese and Western Medicine ,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
WANG Lan(Department of Respiratory and Critical Care Medicine,Pneumology Group,,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
ZHANG Hong-ping(Department of Integrated Traditional Chinese and Western Medicine ,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
FU Juan-juan(Department of Respiratory and Sleep Medicine,John Hunter Hospital,Hunter Medical Research Institute,Newcastle University,NSW 2305,Australia)
WANG Lei(Department of Integrated Traditional Chinese and Western Medicine ,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
JI Yu-lin(Department of Respiratory and Critical Care Medicine,Pneumology Group,,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
WANG Gang(Department of Integrated Traditional Chinese and Western Medicine ,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,China)
Journal Title:
Chinese Medical Journal
Issue:
Volume 125, Issue 17, 2012
DOI:
10.3760/cma.j.issn.0366-6999.2012.17.005
Key Word:
asthma control test;future risk; asthma exacerbation

Abstract: Background The performance of asthma control test (ACT) at baseline for predicting future risk of asthma exacerbation has not been previously demonstrated.This study was designed to explore the ability of the baseline ACT score to predict future risk of asthma exacerbation during a 12-month follow-up.Methods This post hoc analysis included data from a 12-month prospective cohort study in patients with asthma (n=290).The time to the first asthma exacerbation was analyzed and the association between baseline ACT scores and future risk of asthma exacerbation was calculated as adjusted odds ratio (OR) using Logistic regression models.Further,sensitivity and specificity were estimated at each cut-point of ACT scores for predicting asthma exacerbations.Results The subjects were divided into three groups,which were uncontrolled (U,n=128),partly-controlled (PC,n=111),and well controlled (C,n=51) asthma.After adjustment,the decreased ACT scores at baseline in the U and PC groups were associated with an increased probability of asthma exacerbations (OR 3.65 and OR 5.75,respectively),unplanned visits (OR 8.03 and OR 8.21,respectively) and emergency visits (OR 20.00 and OR 22.60,respectively) over a 12-month follow-up period.The time to the first asthma exacerbation was shorter in the groups with U and PC asthma (all P<0.05).The baseline ACT of 20 identified as the cut-point for screening the patients at high risk of asthma exacerbations had an increased sensitivity of over 90.0% but a lower specificity of about 30.0%.Conclusion Our findings indicate that the baseline ACT score with a high sensitivity could rule out patients at low risk of asthma exacerbations and oredict future risk of asthma exacerbations in clinical practice.

  • 1.GINA Report.Global strategy for asthma management and prevention.Revised 2010.(Available at:http://www.ginasthma.org/Reportltem.asp?11 =2&l2 =2&intld =94).
  • 2.Reddel HK,Taylor DR,Bateman ED,Boulet LP,Boushey HA,Busse WW,et al.American Thoracic Society/Enropean Respiratory Society Task Force on Asthma Control and Exacerbations.An official American Thoracic Society/European Respiratory Society statement:asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice.Am J Respir Crit Care Med 2009; 180:59-99.
  • 3.Chapman KR,Boulet LP,Rea RM,Franssen E.Suboptimal asthma control:prevalence,detection and consequences in general practice.Eur Respir J 2008; 31:320-325.
  • 4.Peters SP,Jones CA,Haselkom,T,Mink DR,Valacer DJ,Weiss ST.Real-world Evaluation of Asthma Control and Treatment (REACT):findings from a national Web-based survey.J Allergy Clin Immunol 2007; 119:1454-1461.
  • 5.Partridge MR,van der Molen T,Myrseth SE,Busse WW.Attitudes and actions of asthma patients on regular maintenance therapy:the INSPIRE study.BMC Pulm Med 2006; 6:13.
  • 6.Bateman ED,Boushey HA,Bousquet J,Busse WW,Clark TJ,Pauwels RA,et al.GOAL Investigators Group.Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control study.Am J Respir Crit Care Med 2004; 170:836-844.
  • 7.Accordini S,Corsico A,Cerveri I,Gislason D,Gulsvik A,Janson C,et al.Therapy and Health Economics Working Group of the European Community Respiratory Health Survey Ⅱ.The socio-economic burden of asthma is substantial in Europe.Allergy 2008; 63:116-124.
  • 8.Masoll M,Fabian D,Holt S,Beasley R.Global burden of astma.2004.(Accessed December 18, 2011:http://www.ginasthma.org/pdf/GINABurdenReport.pdf).
  • 9.Meltzer EO,Busse WW,Wenzel SE,Belozeroff V,Weng HH,Feng JY,et al.Use of the Asthma Control Questionnaire to predict future risk of asthma exacerbation.J Allergy Clin Immunol 2011; 127:167-172.
  • 10.Bateman ED,Reddel HK,Eriksson G,Peterson S,Ostlund O,Sears MR,et al.Overall asthma control:the relationship between current control and future risk.J Allergy Clin Immunol 2010; 125:600-608.
  • 11.Vollmer WM,Markson LE,O'Connor E,Sanocki LL,Fitterman L,Berger M,et al.Association of asthma control with health care utilization and quality of life.Am J Respir Crit Care Med 1999; 160:1647-1652.
  • 12.Vollmer WM,Markson LE,O'Connor E,Frazier EA,Berger M,Buist AS.Association of asthma control with healthcare utilization:a prospective evaluation.Am J Respir Crit Care Med 2002; 165:195-199.
  • 13.Haselkorn T,Fish JE,Zeiger RS,Szefler SJ,Miller DP,Chipps BE,et al; TENOR Study Group.Consistently very poorly controlled asthma,as defined by the impairment domain of the Expert Panel Report 3 guidelines,increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma:Outcomes and Treatment Regimens (TENOR) study.J Allergy Clin Immunol 2009; 124:895-902.
  • 14.Guibert TW,Garris C,Jhingran P,Bonafede M,Tomaszewski KJ.Bonus T,et al.Asthma that is not well-controlled is associated with increased healthcare utilization and decreased quality of life.J Asthma 2011; 48:126-132.
  • 15.Schatz M,Zeiger RS,Drane A,Harden K,Cibildak A,Oosterman JE,et al.Reliability and predictive validity of the Asthma Control Test administered by telephone calls using speech recognition technology.J Allergy Clin Immunol 2007;119:336-343.
  • 16.Nathan RA,Sorkness CA,Kosinski M,Schatz M,Li JT,Marcus P,et al.Development of the asthma control test:a survey for assessing asthma control.J Allergy Clin lmmunol 2004; 113:59-65.
  • 17.Juniper EF,O'Byrne PM,Guyatt GH,Ferrie PG,King DR.Development and validation of a questionnaire to measure asthma control.Eur Respir J 1999; 14:902-907.
  • 18.Boulet LP,Boulet V,Milot J.How should we quantify asthma control? A proposal.Chest 2002; 122:2217-2223.
  • 19.Zhou X,Ding FM,Lin JT,Yin KS,Chen P,He QY,et al.Validity of Asthma Control Test in Chinese patients.Chin Med J 2007; 120:1037-1041.
  • 20.Zhou X,Ding FM,Lin JT,Yin KS.Validity of asthma control test for asthma control assessment in Chinese primary care settings.Chest 2009; 135:904-910.
  • 21.Wang G,Zhou T,Wang L,Wang L,Fu JJ,Zhang HP,et al.Relationship between current psychological symptoms and future risk of asthma outcomes:a 12-month prospective cohort study.J Asthma 2011; 48:1041-1050.
  • 22.Juniper EF,O'Byrne PM,Guyatt GH,Ferric PG,King DR.Development and validation of a questionnaire to measure asthma control.Eur Respir J 1999; 14:902-907.
  • 23.Li F,Chai YY,Wang PL.Development of a questionnaire of quality of life for asthma and preliminary evaluation.Chin J Behav Med Sci 1995; 4:193-195.
  • 24.Xu KF,Luo XC,Chen Y,Zhang Y J,Li Y,Hu B,et al.The use of Juniper's asthma quality of life questionnaire in Chinese asthmatics.Chin J Intern Med (Chin) 2003; 42:760-763.
  • 25.American Lung Association Asthma Clinical Research Centers,Peters SP,Anthonisen N,Castro M,Holbrook JT,Irvin CG,Smith LJ,et al.Randomized comparison of strategies for reducing treatment in mild persistent asthma.N Engl J Med 2007; 356:2027-2039.
  • 26.Schatz M,Kosinski M,Yarlas AS,Hanlon J,Watson M,Jhingran P.The minimally important difference of the Asthma Control Test.J Allergy Clin Immunol 2009; 124:719-723.
  • 27.Tabachnick BG,Fidell LS.Multiple regression.Jn:Using multivariate statistics.Boston:Allyn & Bacon 2001:117.
  • 28.Schatz M,Sorkness CA,Li.JT,Marcus P,Murray JJ,Nathan RA,et al.Asthma Control Test:reliability,validity,and responsiveness in patients not previously followed by asthma specialists.J Allergy Clin Immunol 2006; 117:549-556.
  • 29.Wang G,Wang L,Szczepaniak WS,Xiong ZY,Wang L,Zhou T,et al.Psychological status in uncontrolled asthma is not related to airway hyperresponsiveness.J Asthma 2010; 47:93-99.
  • 30.Zhou T,Zhang HP,Chen WW,Xiong ZY,Fan T,Fu JJ,et al.Cuff-leak test for predicting postextubation airway complications:a systematic review.J Evid Based Med 2011;4:242-254.
  • 31.Jones CM,Athanasiou T.Summary receiver operating characteristic curve analysis techniques in the evaluation of diagnostic tests.Ann Thorac Surg 2005; 79:16-20.
  • 32.Fisher-Owens SA,Boddupalli G,Thyne SM.Telephone case management for asthma: an acceptable and effective intervention within a diverse pediatric population.J Asthma 2011; 48:156-161.
  • 33.Liu WT,Huang CD,Wang CH,Lee KY,Lin SM,Kuo HP.A mobile telephone-based interactive self-care system improves asthma control.Eur Respir J 2011; 37:310-317.
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