Original Articles: Asthma Lower Airway Diseases
Factors associated with severity and exacerbation of asthma: a baseline analysis of the COhort for Reality and Evolution of adult Asthma in Korea (COREA)

https://doi.org/10.1016/S1081-1206(10)60530-3Get rights and content

Background

Asthma presents with heterogeneous features, and patients show various phenotypes of differing severities. Therefore, it is necessary to define reliable predictable clinical factors that influence severity. To date, few large-scale studies have gathered clinical data on adult asthma patients in Asia.

Objectives

To establish an adult asthma cohort in Korea and to define significant factors associated with asthma severity and exacerbation.

Methods

Researchers from 11 university hospitals have established an asthma cohort termed the COhort for Reality and Evolution of adult Asthma in Korea (COREA). We classified the severity of asthma into 3 groups: mild, moderate, and severe. In this article, the first analysis of our cohort, we evaluate various clinical factors associated with the severity and exacerbation of asthma using data from 1,260 asthma patients.

Results

Physician-evaluated severity of asthma was associated with a history of asthma exacerbation (P < .001), a history of smoking (P < .001), symptom duration (P = .007), and treatment duration (P < .001). It was also significantly correlated with predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) values and FEV1/FVC ratio (all P < .001). Previous exacerbation was associated with smoking (P = .02), predicted FVC and FEV1 values (both P < .001), FEV1/FVC ratio (P = .02), airway hyperresponsiveness (P = .002), and duration of disease (P < .001).

Conclusions

Previous exacerbation, duration of disease, and decrease in lung function were important clinical indices associated with asthma severity in the COREA study patients. Our long-term follow-up study is expected to soon yield more accurate and detailed outcomes.

Section snippets

INTRODUCTION

Asthma is a heterogeneous chronic obstructive airway disease, and patients present with various clinical phenotypes of differing severities. Therefore, long-term changes must be monitored in a large patient group. Although some long-term follow-up asthma observational studies have been performed on young children or on birth cohorts, few cohort studies have been performed on adult asthma patients of the whole spectrum of severity from mild to severe to date.1, 2

The representative adult asthma

Establishment and Design of the Cohort

The COhort for Reality and Evolution of adult Asthma in Korea (COREA) study is a prospective, observational, multicentered, 9-year (2005-2013), follow-up study of Korean patients diagnosed as having asthma. The patients are recruited by allergists or pulmonologists from 11 centers in diverse areas of Korea; the participating institutions are the Asan Medical Center at the University of Ulsan and hospitals of Seoul National University, Bundang Seoul National University, Yonsei University,

Demographic Data

Baseline demographic data and clinical characteristics of the study participants in this analysis are given in Table 1. The mean age of participants is 49 years, and there are approximately 1.24 times more women than men. The ratio of atopy to nonatopy is 0.63, as generally found. Our patients have experienced respiratory symptoms for a mean of 10.20 years, were diagnosed as having asthma an average of 8.29 years ago, and have been treated by physicians for a mean of 6.42 years. Most patients

DISCUSSION

The new guidelines prepared by GINA in 2006 introduced the concept of asthma control.12 Although the concept of control provides convenient standards that can be easily applied to clinical situations, control has a dynamic aspect; hence, focus on control only may neglect the intrinsic asthmatic condition, compared with classification of severity primarily based on lung function tests. Therefore, the present study evaluated the severity of asthma by physician primarily based on the earlier GINA

ACKNOWLEDGMENTS

The COREA Study Group includes the following investigators: Professor Hee-Bom Moon, Professor You Sook Cho, Professor Tae-Bum Kim (University of Ulsan), Professor Sang-Heon Cho, Professor Heung-Woo Park (Seoul National University), Professor Yoon-Seok Chang (Bundang Seoul National University), Professor Jung Won Park (Yonsei University), Professor Byoung-Whui Choi (Chungang University), Professor Young-Joo Cho (Ewha Womans University), Professor Ho-Joo Yoon, Professor Sang-Heon Kim (Hanyang

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  • Cited by (0)

    Dr Cho and Dr Moon contributed equally to this article.

    Disclosures: Authors have nothing to disclose.

    Funding Sources: This study was supported by grant A040153 from the Korean Health 21 R&D Project, Ministry of Health & Welfare, Republic of Korea.

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