A new index of prognostic severity for chronic asthma.
OBJECTIVE
To develop a prognostic clinical index for adults with chronic stable asthma.


METHODS
Analysis of data from a 48-week randomized, crossover trial of regular vs as-needed inhaled beta-agonist therapy.


METHODS
Eligible patients included 70 men and women between the ages of 15 and 64 years with asthma for > 1 year.


METHODS
Asthma deterioration within 20 weeks, defined as either a marked decline in FEV1 (> or = 1.0 L or > or = 30% from baseline) or initiation of systemic corticosteroid therapy for asthma exacerbation.


RESULTS
Three baseline factors independently predicted asthma deterioration: frequent symptoms on waking in the 4 weeks before baseline, past hospitalization for asthma, and age 35 years or older. Based on cross-stratification and consolidation of these prognostic factors, an index was developed that stratified subjects into four risk groups with distinctive deterioration rates of 9%, 21%, 39%, and 67% (p<0.001).


CONCLUSIONS
For adults with chronic stable asthma, three simple clinical factors can be combined to stratify effectively for risk of subsequent asthma deterioration.
Ellman
M S
MS
Department of Medicine, Yale University School of Medicine, New Haven, Conn 06520, USA.
Viscoli
C M
CM
Sears
M R
MR
Taylor
D R
DR
Beckett
W S
WS
Horwitz
R I
RI
D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D000328:Adult; D000367:Age Factors; D000402:Airway Obstruction / Q000503:physiopathology; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy / Q000503:physiopathology; D001993:Bronchodilator Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002908:Chronic Disease; D002940:Circadian Rhythm; D018592:Cross-Over Studies; D005260:Female; D005541:Forced Expiratory Volume / Q000187:drug effects / Q000502:physiology; D005544:Forecasting; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D009298:Nasal Polyps / Q000503:physiopathology; D010366:Peak Expiratory Flow Rate / Q000187:drug effects / Q000502:physiology; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D001993:Bronchodilator Agents