Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: Role of predictors in the setting of high adherence

Rebecca S. Gruchalla, Hugh A. Sampson, Elizabeth Matsui, Gloria David, Peter J. Gergen, Agustin Calatroni, Mark A Brown, Andrew H. Liu, Gordon R. Bloomberg, James F. Chmiel, Rajesh Kumar, Carin Lamm, Ernestine Smartt, Christine A. Sorkness, Suzanne F. Steinbach, Kelly D. Stone, Stanley J. Szefler, William W. Busse

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Background: With the expanding effort to provide guidelines-based therapy to adolescents with asthma, attention must be directed to evaluating which factors predict future asthma control when guidelines-based management is applied. Objective: We evaluated the role of fraction of exhaled nitric oxide in parts per billion, markers of allergic sensitization, airway inflammation, and measures of asthma severity in determining future risk of asthma symptoms and exacerbations in adolescents and young adults participating in the Asthma Control Evaluation study. Methods: Five hundred forty-six inner-city residents, ages 12 through 20 years, with persistent asthma were extensively evaluated at study entry for predictors of future symptoms and exacerbations over the subsequent 46 weeks, during which guidelines-based, optimal asthma management was offered. Baseline measurements included fraction of exhaled nitric oxide in parts per billion, total IgE, allergen-specific IgE, allergen skin test reactivity, asthma symptoms, lung function, peripheral blood eosinophils, and, for a subset, airway hyperresponsiveness and sputum eosinophils. Results: The baseline characteristics we examined accounted for only a small portion of the variance for future maximum symptom days and exacerbations-11.4% and 12.6%, respectively. Future exacerbations were somewhat predicted by asthma symptoms, albuterol use, previous exacerbations, and lung function, whereas maximum symptom days were predicted, also to a modest extent, by symptoms, albuterol use, and previous exacerbations, but not lung function. Conclusion: Our findings demonstrate that the usual predictors of future disease activity have little predictive power when applied to a highly adherent population with persistent asthma that is receiving guidelines-based care. Thus, new predictors need to be identified that will be able to measure the continued fluctuation of disease that persists in highly adherent, well-treated populations such as the one studied.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology
Volume124
Issue number2
DOIs
StatePublished - Aug 2009

Fingerprint

Asthma
Guidelines
Morbidity
Therapeutics
Albuterol
Eosinophils
Lung
Allergens
Immunoglobulin E
Nitric Oxide
Skin Tests
Sputum
Population
Young Adult
Inflammation

Keywords

  • airway inflammation
  • allergic sensitization
  • Asthma
  • asthma severity
  • exhaled nitric oxide
  • inner-city

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Asthma morbidity among inner-city adolescents receiving guidelines-based therapy : Role of predictors in the setting of high adherence. / Gruchalla, Rebecca S.; Sampson, Hugh A.; Matsui, Elizabeth; David, Gloria; Gergen, Peter J.; Calatroni, Agustin; Brown, Mark A; Liu, Andrew H.; Bloomberg, Gordon R.; Chmiel, James F.; Kumar, Rajesh; Lamm, Carin; Smartt, Ernestine; Sorkness, Christine A.; Steinbach, Suzanne F.; Stone, Kelly D.; Szefler, Stanley J.; Busse, William W.

In: Journal of Allergy and Clinical Immunology, Vol. 124, No. 2, 08.2009.

Research output: Contribution to journalArticle

Gruchalla, RS, Sampson, HA, Matsui, E, David, G, Gergen, PJ, Calatroni, A, Brown, MA, Liu, AH, Bloomberg, GR, Chmiel, JF, Kumar, R, Lamm, C, Smartt, E, Sorkness, CA, Steinbach, SF, Stone, KD, Szefler, SJ & Busse, WW 2009, 'Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: Role of predictors in the setting of high adherence', Journal of Allergy and Clinical Immunology, vol. 124, no. 2. https://doi.org/10.1016/j.jaci.2009.05.036
Gruchalla, Rebecca S. ; Sampson, Hugh A. ; Matsui, Elizabeth ; David, Gloria ; Gergen, Peter J. ; Calatroni, Agustin ; Brown, Mark A ; Liu, Andrew H. ; Bloomberg, Gordon R. ; Chmiel, James F. ; Kumar, Rajesh ; Lamm, Carin ; Smartt, Ernestine ; Sorkness, Christine A. ; Steinbach, Suzanne F. ; Stone, Kelly D. ; Szefler, Stanley J. ; Busse, William W. / Asthma morbidity among inner-city adolescents receiving guidelines-based therapy : Role of predictors in the setting of high adherence. In: Journal of Allergy and Clinical Immunology. 2009 ; Vol. 124, No. 2.
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abstract = "Background: With the expanding effort to provide guidelines-based therapy to adolescents with asthma, attention must be directed to evaluating which factors predict future asthma control when guidelines-based management is applied. Objective: We evaluated the role of fraction of exhaled nitric oxide in parts per billion, markers of allergic sensitization, airway inflammation, and measures of asthma severity in determining future risk of asthma symptoms and exacerbations in adolescents and young adults participating in the Asthma Control Evaluation study. Methods: Five hundred forty-six inner-city residents, ages 12 through 20 years, with persistent asthma were extensively evaluated at study entry for predictors of future symptoms and exacerbations over the subsequent 46 weeks, during which guidelines-based, optimal asthma management was offered. Baseline measurements included fraction of exhaled nitric oxide in parts per billion, total IgE, allergen-specific IgE, allergen skin test reactivity, asthma symptoms, lung function, peripheral blood eosinophils, and, for a subset, airway hyperresponsiveness and sputum eosinophils. Results: The baseline characteristics we examined accounted for only a small portion of the variance for future maximum symptom days and exacerbations-11.4{\%} and 12.6{\%}, respectively. Future exacerbations were somewhat predicted by asthma symptoms, albuterol use, previous exacerbations, and lung function, whereas maximum symptom days were predicted, also to a modest extent, by symptoms, albuterol use, and previous exacerbations, but not lung function. Conclusion: Our findings demonstrate that the usual predictors of future disease activity have little predictive power when applied to a highly adherent population with persistent asthma that is receiving guidelines-based care. Thus, new predictors need to be identified that will be able to measure the continued fluctuation of disease that persists in highly adherent, well-treated populations such as the one studied.",
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AU - David, Gloria

AU - Gergen, Peter J.

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AU - Liu, Andrew H.

AU - Bloomberg, Gordon R.

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AU - Kumar, Rajesh

AU - Lamm, Carin

AU - Smartt, Ernestine

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