title: Recent asthma exacerbations predict future exacerbations in children with severe or difficult-to-treat asthma.
abstract: BACKGROUND
  Children with severe/difficult-to-treat asthma experience high morbidity including frequent severe exacerbations. More knowledge is required to identify predictors of these exacerbations to reduce their occurrence.
  
  
  OBJECTIVE
  To investigate the risk of future severe exacerbations (FSEs) in children with severe/difficult-to-treat asthma and recent severe exacerbations (RSEs).
  
  
  METHODS
  We analyzed the occurrence and association of RSE (defined as 1 or more corticosteroid bursts during the 3 months before each of 3 annual visits) and FSE (defined as 1 or more corticosteroid bursts 6 or 12 months later) in children age 6 to 11 years in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens 3-year observational study. Repeated measures logistic regression analysis assessed the risk of FSE adjusted for demographics and clinical variables.
  
  
  RESULTS
  In a multivariable model, FSE at 6 months was most strongly predicted by RSE (odds ratio [OR], 3.08; 95% CI, 2.21-4.28) and having 3 to 4 allergic triggers (OR, 2.05; 95% CI, 1.31-3.20). Race (OR, 1.77; 95% CI, 1.25-2.51) and being very poorly controlled according to the impairment component of the National Heart, Lung, and Blood Institute guidelines (OR, 1.59; 95% CI, 1.14-2.23) also significantly predicted FSE.
  
  
  CONCLUSIONS
  Recent severe asthma exacerbations are an important independent predictor of FSE in children with severe/difficult-to-treat asthma and should be considered when establishing asthma management plans.
authors.affiliation: Genentech, Inc, South San Francisco, Calif, USA. haselkorn.tmirah@gene.com
authors.forename: Tmirah
authors.initials: T
authors.lastname: Haselkorn
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.forename: Bradley E
authors.initials: BE
authors.lastname: Chipps
authors.forename: David R
authors.initials: DR
authors.lastname: Mink
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
authors.forename: F Estelle R
authors.initials: FE
authors.lastname: Simons
authors.forename: Marc
authors.initials: M
authors.lastname: Massanari
authors.forename: James E
authors.initials: JE
authors.lastname: Fish
mesh_terms: D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology*; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
chemical_list: D018927:Anti-Asthmatic Agents