Assessing Future Need for Acute Care in Adult Asthmatics: The Profile of Asthma Risk Study: A Prospective Health Maintenance Organization-Based Study

doi:10.1378/chest.05-3084

Chest

Volume 132, Issue 4, October 2007, Pages 1151-1161

https://doi.org/10.1378/chest.05-3084 Get rights and content

Study objectives

To develop simple clinical tools predictive of acute asthma care and to identify modifiable risk factors.

Design

Prospective cohort study.

Setting

A large health maintenance organization (430,000 members).

Patients/participants

Adult members (18 to 55 years old) with asthma.

Interventions

Data from a questionnaire, skin-prick testing for inhalant allergens, and spirometry were collected at the baseline visit. Acute care utilization data were obtained from administrative databases for a subsequent 30-month period.

Methods

This two-phase study first identified and performed a split-sample validation on three clinical tools to determine their predictive ability by employing data from a questionnaire, questionnaire plus spirometry, and questionnaire plus spirometry and skin-prick testing. Second, it identified modifiable independent risk factors.

Measurements and results

The 554 study participants generated 173 episodes of acute care over 1,258 person-years of follow-up (0.14 episodes per person per year). Of these, 101 participants had at least one episode, and one third of this group had two or more episodes. Clinical scoring into risk groups was done by reverse stepwise regression analyses. Using relative risks (RRs) as a guide, high-risk, moderate-risk, and low-risk groups were identified. The high-risk groups, 13 to 21% of the validation sample, had a 7- to 11-fold increased risk for hospital care compared to the low-risk groups. The moderate-risk groups, 46 to 50% of the validation sample, had a twofold- to fourfold-increased risk. FEV₁ was the most significant predictor (RR, 4.33). Of the four potentially modifiable risk factors identified, current cigarette smoke exposure (RR, 1.6) and ownership and skin-prick test positivity to cat or dog (RR, 1.5) were the most significant.

Conclusions

These models stratify asthma patients at risk for acute care. Patients with lower FEV₁ values are at significantly higher risk, underscoring the importance of spirometry in asthma care.

Section snippets

Methods and Materials

The study methods and characteristics of the population have been described in detail elsewhere¹⁷ and are summarized here.

Results

The 554 study participants were predominantly white and never-smokers, more than half were women (61%), and had a median annual income < $50,000 (Table 1). Median age of the participants was 41 years. We grouped education into grades 0 to 8 (n = 1, 0.2%), grades 9 to 12 (n = 102, 18.4%), some college (n = 225, 40.6%), and college graduate (n = 226, n = 40.8%). ETS during the past 12 months was common (40.3%). There were 173 episodes of acute care over 1,258 person-years of follow-up, for an

Discussion

We successfully developed three simple clinical models using independent risk factors suitable for use in the clinical setting that stratify adult asthma patients into risk groups. We identified and validated the models to determine their predictive ability. The high-risk groups, 13 to 21% of the validation sample populations, were at roughly 7- to 11-fold–increased risk for acute care compared to the low-risk groups. The moderate-risk groups, 46 to 50% of the validation sample, were at twofold

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Supported by National Institutes of Health grant HL #48237; the American Lung Association of Oregon; VA Foundation acct #279999; and the Allergy Clinic, Portland, OR.

This study was conducted at Kaiser Permanente Northwest, Portland OR.

The authors have no conflicts on interest to disclose.

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Chest

ORIGINAL RESEARCHASTHMAAssessing Future Need for Acute Care in Adult Asthmatics: The Profile of Asthma Risk Study: A Prospective Health Maintenance Organization-Based Study

Study objectives

Design

Setting

Patients/participants

Interventions

Methods

Measurements and results

Conclusions

Section snippets

Methods and Materials

Results

Discussion

J Allergy Clin Immunol

J Allergy Clin Immunol

J Allergy Clin Immunol

Chest

Chest

J Allergy Clin Immunol

Mayo Clin Proc

J Allergy Clin Immunol

Chest

J Allergy Clin Immunol

Chest

Respir Med

Ann Allergy Asthma Immunol

J Allergy Clin Immunol

A longitudinal, population-based, cohort study of childhood asthma followed to adulthood

N Engl J Med

Asthma, airway biology, and nasal disorders in AJRCCM 2003

Am J Respir Crit Care Med

NAEP Expert Panel report 2: guidelines for the diagnosis and management of asthma; update on selected topics 2002

Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma Control Study

Am J Respir Crit Care Med

An economic evaluation of asthma in the United States

N Engl J Med

Healthy people 2000: national promotion and disease prevention objectives; full report, with commentary

The influence of age and sex on asthma admissions

JAMA

Computer-based models to identify high-risk children with asthma

Am J Respir Crit Care Med

Association of asthma control with health care utilization and quality of life

Am J Respir Crit Care Med

Asthma and cigarette smoking

Eur Respir J

ORIGINAL RESEARCH
ASTHMA
Assessing Future Need for Acute Care in Adult Asthmatics: The Profile of Asthma Risk Study: A Prospective Health Maintenance Organization-Based Study