RT Journal Article
SR Electronic
T1 Predictors of severe asthma exacerbations, poor asthma control and beta-agonist overuse in adult asthma
JF European Respiratory Journal
JO Eur Respir J
FD European Respiratory Society
SP P776
VO 42
IS Suppl 57
A1 Mark Weatherall
A1 Mitesh Patel
A1 Janine Pilcher
A1 Helen Reddel
A1 Dominick Shaw
A1 Richard Beasley
YR 2013
UL http://erj.ersjournals.com/content/42/Suppl_57/P776.abstract
AB Background Predictors of severe asthma exacerbations, poor asthma control or beta-agonist overuse may be of clinical utility in the management of adult asthma patients. Aim To determine the baseline characteristics that are predictors of subsequent adverse outcomes. Methods A 24-week, open-label, parallel-group, multicentre RCT of 303 asthma patients studied the efficacy & safety of single budesonide/formoterol inhaler as maintenance & reliever therapy (SMART) or a fixed-dose regimen with salbutamol as reliever (‘Standard’). Inhaled medication use was measured by electronic monitoring. Baseline characteristics that were predictors of future severe asthma exacerbations, poor control [Asthma Control Questionnaire (ACQ)-5 score ≥1.5 at 6 months] & ‘extreme’ beta-agonist overuse [>20 total budesonide/formoterol actuations/day in SMART and >32 salbutamol actuations/day in Standard], were assessed by multivariate analyses. Results Lower FEV1 % predicted [Odds Ratio (OR) (95% CI) 1.19 (1.02-1.39) per 10%], Standard therapy [OR 2.07 (1.19-3.60)], & female gender [OR 2.21 (1.15-4.24] were associated with greater risk of severe exacerbations. Higher ACQ-5 score [OR 1.45 (1.18-1.77) per 0.5 points] & older age [OR 1.04 (1.01-1.06) per decade] were associated with greater risk of poor control. Higher self-reported reliever use [OR 1.61 (1.23-2.12) per categorical score in ACQ question 6] & female gender [OR 2.06 (1.06-4.01] were associated with greater risk of extreme overuse. Conclusion Future severe asthma exacerbations, poor asthma control & beta-agonist overuse are predicted by different baseline characteristics & management approaches. Funding Health Research Council of New Zealand.