Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study.
Patients with severe or difficult-to-treat asthma are an understudied population but account for considerable asthma morbidity, mortality, and costs. The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study was a large, 3-year, multicenter, observational cohort study of 4756 patients (n=3489 adults ≥ 18 years of age, n=497 adolescents 13-17 years of age, and n=770 children 6-12 years of age) with severe or difficult-to-treat asthma. TENOR's primary objective was to characterize the natural history of disease in this cohort. Data assessed semiannually and annually included demographics, medical history, comorbidities, asthma control, asthma-related health care use, medication use, lung function, IgE levels, self-reported asthma triggers, and asthma-related quality of life. We highlight the key findings and clinical implications from more than 25 peer-reviewed TENOR publications. Regardless of age, patients with severe or difficult-to-treat asthma demonstrated high rates of health care use and substantial asthma burden despite receiving multiple long-term controller medications. Recent exacerbation history was the strongest predictor of future asthma exacerbations. Uncontrolled asthma, as defined by the 2007 National Heart, Lung, and Blood Institute guidelines' impairment domain, was highly prevalent and predictive of future asthma exacerbations; this assessment can be used to identify high-risk patients. IgE and allergen sensitization played a role in the majority of severe or difficult-to-treat asthmatic patients.
Capital Allergy & Respiratory Disease Center, Sacramento, CA 95819, USA. bchipps@capitalallergy.com
Bradley E
BE
Chipps
Robert S
RS
Zeiger
Larry
L
Borish
Sally E
SE
Wenzel
Ashley
A
Yegin
Mary Lou
ML
Hayden
Dave P
DP
Miller
Eugene R
ER
Bleecker
F Estelle R
FE
Simons
Stanley J
SJ
Szefler
Scott T
ST
Weiss
Tmirah
T
Haselkorn
D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000485:Allergens / Q000276:immunology; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000503:physiopathology; D002170:Canada / Q000453:epidemiology; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007073:Immunoglobulin E / Q000097:blood / Q000276:immunology; D008168:Lung / Q000187:drug effects / Q000503:physiopathology; D008297:Male; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D011788:Quality of Life; D012129:Respiratory Function Tests; D012720:Severity of Illness Index; D012737:Sex Factors; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
D000485:Allergens; D018927:Anti-Asthmatic Agents; D007073:Immunoglobulin E