title: Can we predict fall asthma exacerbations? Validation of the seasonal asthma exacerbation index.
abstract: BACKGROUND
  A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on 2 prior National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium trials.
  
  
  OBJECTIVE
  This study sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy.
  
  
  METHODS
  The saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study. We characterized those inner-city children with and without asthma exacerbations in the fall period treated with guidelines-based therapy (GBT) in the absence and presence of omalizumab.
  
  
  RESULTS
  A higher saEPI was associated with an exacerbation in both the GBT alone (P < .001; area under the curve, 0.76) and the GBT + omalizumab group (P < .01; area under the curve, 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percentage and number, and higher treatment step were associated with those who had an exacerbation compared with those who did not. In the GBT + omalizumab group, younger age at recruitment, increased eosinophil number, recent exacerbation, and higher treatment step were also associated with those who had an exacerbation. The saEPI was associated with a high negative predictive value in both groups.
  
  
  CONCLUSIONS
  An exacerbation in children treated with GBT with or without omalizumab was associated with a higher saEPI along with higher markers of allergic inflammation, treatment step, and a recent exacerbation. Those that exacerbated on omalizumab had similar features with the exception of some markers of allergic sensitization, indicating a need to develop better markers to predict poor response to omalizumab therapy and alternative treatment strategies for children with these risk factors. The saEPI was able to reliably predict those children unlikely to have an asthma exacerbation in both groups.
authors.affiliation: Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo. Electronic address: Heather.hoch@childrenscolorado.org.
authors.forename: Heather E
authors.initials: HE
authors.lastname: Hoch
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Agustin
authors.initials: A
authors.lastname: Calatroni
authors.affiliation: Boston University School of Medicine, Boston, Mass.
authors.forename: Joseph B
authors.initials: JB
authors.lastname: West
authors.affiliation: Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Andrew H
authors.initials: AH
authors.lastname: Liu
authors.affiliation: National Institute of Allergy and Infectious Diseases, Bethesda, Md.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Gergen
authors.affiliation: University of Texas Southwestern Medical Center, Dallas, Tex.
authors.forename: Rebecca S
authors.initials: RS
authors.lastname: Gruchalla
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Gurjit K
authors.initials: GK
authors.lastname: Khurana Hershey
authors.affiliation: Cincinnati Children's Hospital, Cincinnati, Ohio.
authors.forename: Carolyn M
authors.initials: CM
authors.lastname: Kercsmar
authors.affiliation: Henry Ford Health System, Detroit, Mich.
authors.forename: Haejin
authors.initials: H
authors.lastname: Kim
authors.affiliation: Columbia University College of Physicians and Surgeons, New York, NY.
authors.forename: Carin I
authors.initials: CI
authors.lastname: Lamm
authors.affiliation: Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
authors.forename: Melanie M
authors.initials: MM
authors.lastname: Makhija
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Herman E
authors.initials: HE
authors.lastname: Mitchell
authors.affiliation: Children's National Health System, Washington, DC.
authors.forename: Stephen J
authors.initials: SJ
authors.lastname: Teach
authors.affiliation: Rho Federal Systems Division, Chapel Hill, NC.
authors.forename: Jeremy J
authors.initials: JJ
authors.lastname: Wildfire
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wis.
authors.forename: William W
authors.initials: WW
authors.lastname: Busse
authors.affiliation: Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
authors.forename: Stanley J
authors.initials: SJ
authors.lastname: Szefler
mesh_terms: D000818:Animals; D018926:Anti-Allergic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000175:diagnosis* / Q000453:epidemiology; D002648:Child; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D000069444:Omalizumab / Q000627:therapeutic use*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D011379:Prognosis; D012307:Risk Factors; D012621:Seasons; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology; D014505:Urban Population
chemical_list: D018926:Anti-Allergic Agents; D000069444:Omalizumab
keywords: Fall asthma exacerbation; Seasonal Asthma Exacerbation Predictive Index (saEPI); asthma exacerbation predictors; guidelines-based therapy; omalizumab