title: Association between episodes of upper respiratory infection and exacerbations in adult patients with asthma.
abstract: BACKGROUND
  Asthma has several phenotypical features, including recurrent exacerbations and recurrent episodes of upper respiratory infection (URI).
  
  
  OBJECTIVE
  A retrospective study was performed to identify the characteristics of adult patients with recurrent exacerbations of asthma, especially in association with recurrent episodes of URI.
  
  
  METHODS
  Information was collected using a self-administered questionnaire given to 7070 patients in autumn-winter 2006, 4859 patients in spring-summer 2007, and 4452 patients in autumn-winter 2007. The patients reported the degree of symptoms and the frequency of febrile episodes of URI and exacerbations. Severe exacerbations were defined as a self-report of asthma-related hospitalization, an emergency department visit, or a requirement for systemic corticosteroids. Recurrent febrile URI and exacerbations were defined as two or more episodes within the previous 6 months. A Poisson regression model was used to identify the factors that were predictors of a risk for exacerbations.
  
  
  RESULTS
  Of the 6266 patients who completed the questionnaire, the frequencies of febrile URI and episodes of severe exacerbations were 1.54 and 0.54 per subject per year, respectively. Logistic regression analysis showed that an older age [odds ratio (OR): 1.57; 95% confidence interval (CI): 1.15-2.13], female sex (OR: 1.58; 95% CI: 1.20-2.08), recurrent febrile episodes of URI (OR: 2.68; 95% CI: 1.47-4.91), a history of previous exacerbation within 1 year (OR: 1.74; 95% CI: 1.28-2.34), disuse of inhaled corticosteroids (ICSs) (OR: 2.63; 95% CI: 1.68-4.12), and disuse of add-on leukotriene receptor antagonists (LTRAs) (OR: 1.42; 95% CI: 1.06-1.74) were independently associated with moderate to severe symptom-severity. Poisson regression analysis showed that the independent factors that contributed to the frequency of recurrent severe exacerbations were female sex (regression coefficient β = 0.62, p < .01), an episode of sputum with coughing (β = 1.23, p < .01), nocturnal awakening (β = 1.22, p < .01), and severe exacerbation (β = 0.78, p < .01) within the previous 6 months.
  
  
  CONCLUSIONS
  Symptom-severity of asthma and the frequency of severe exacerbations were associated with previous exacerbations and susceptibility to URI.
authors.affiliation: Department of Respiratory Medicine and Allergology, Faculty of Medicine, Kinki University, Osaka, Japan. tom0223@ko-arena.med.kindai.ac.jp
authors.forename: Katsuyuki
authors.initials: K
authors.lastname: Tomita
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Sano
authors.forename: Takashi
authors.initials: T
authors.lastname: Iwanaga
authors.forename: Kyosuke
authors.initials: K
authors.lastname: Ishihara
authors.forename: Masakazu
authors.initials: M
authors.lastname: Ichinose
authors.forename: Ichirou
authors.initials: I
authors.lastname: Kawase
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kimura
authors.forename: Kazuto
authors.initials: K
authors.lastname: Hirata
authors.forename: Masaki
authors.initials: M
authors.lastname: Fujimura
authors.forename: Michiaki
authors.initials: M
authors.lastname: Mishima
authors.forename: Yuji
authors.initials: Y
authors.lastname: Tohda
mesh_terms: D000367:Age Factors; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use; D001249:Asthma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology; D003371:Cough / Q000453:epidemiology; D018450:Disease Progression; D004198:Disease Susceptibility; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D012141:Respiratory Tract Infections / Q000150:complications* / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D007319:Sleep Initiation and Maintenance Disorders / Q000453:epidemiology; D013183:Sputum; D011795:Surveys and Questionnaires; D016903:Drug Monitoring
chemical_list: D018927:Anti-Asthmatic Agents