title: Predictors of asthma exacerbation among patients with poorly controlled asthma despite inhaled corticosteroid treatment.
abstract: BACKGROUND
  Asthma exacerbations are associated with decreased quality of life and increased health care usage. Identification of characteristics that predict increased risk of future exacerbations in patients with suboptimal control of asthma could guide treatment decisions.
  
  
  OBJECTIVE
  To examine patient characteristics associated with risk of asthma exacerbations in patients with uncontrolled persistent asthma.
  
  
  METHODS
  A retrospective analysis of adults and children with inadequately controlled asthma despite asthma controller therapy and enrolled in 2 randomized trials was conducted. Baseline characteristics of subjects who experienced an asthma exacerbation during the treatment period were compared with those of subjects who did not experience an exacerbation.
  
  
  RESULTS
  Of 718 subjects (402 adults and 295 children), 108 adults (27%) and 110 children (37%) experienced an asthma exacerbation during the study period. Unscheduled health care visits for asthma or use of oral corticosteroids in the previous year were significantly associated with asthma exacerbation during the study period (P < .01). Adult subjects who experienced an exacerbation had significantly lower forced expiratory volume in 1 second compared with those who did not (2.3 vs 2.5 L, respectively, P = .02). Children who experienced an exacerbation had lower baseline pre- and post-bronchodilator ratios of forced expiratory volume in 1 second to forced vital capacity (77% vs 81%, P < .01; 82% vs 86%, P < .001, respectively). Symptom scores on validated questionnaires were significantly worse in adults but not in children who developed an exacerbation.
  
  
  CONCLUSIONS
  Spirometric measurements can help identify adults and children at increased risk for asthma exacerbation. Symptom scores could be helpful in identifying adults who are at high risk for exacerbations but could be less helpful in children.
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Wilson
authors.initials: W
authors.lastname: Quezada
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York.
authors.forename: Eun Soo
authors.initials: ES
authors.lastname: Kwak
authors.affiliation: New York University of Medicine, New York, New York.
authors.forename: Joan
authors.initials: J
authors.lastname: Reibman
authors.affiliation: Mount Sinai School of Medicine, New York, New York.
authors.forename: Linda
authors.initials: L
authors.lastname: Rogers
authors.affiliation: Ohio State University, Columbus, Ohio.
authors.forename: John
authors.initials: J
authors.lastname: Mastronarde
authors.affiliation: University of Virginia Medical Center, Charlottesville, Virginia.
authors.forename: William G
authors.initials: WG
authors.lastname: Teague
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Christine
authors.initials: C
authors.lastname: Wei
authors.affiliation: Johns Hopkins University, Baltimore, Maryland.
authors.forename: Janet T
authors.initials: JT
authors.lastname: Holbrook
authors.affiliation: Department of Medicine, Columbia University Medical Center, New York, New York. Electronic address: ead3@columbia.edu.
authors.forename: Emily
authors.initials: E
authors.lastname: DiMango
mesh_terms: D000280:Administration, Inhalation; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy* / Q000503:physiopathology*; D002648:Child; D004311:Double-Blind Method; D005260:Female; D005541:Forced Expiratory Volume; D006801:Humans; D008297:Male; D013147:Spirometry; D011795:Surveys and Questionnaires
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents