Prognostic factors of asthma severity: a 9-year international prospective cohort study

2.50
Hdl Handle:
http://hdl.handle.net/2336/6356
Title:
Prognostic factors of asthma severity: a 9-year international prospective cohort study
Authors:
de Marco, Roberto; Marcon, Alessandro; Jarvis, Deborah; Accordini, Simone; Almar, Enrique; Bugiani, Massimiliano; Carolei, Adriana; Cazzoletti, Lucia; Corsico, Angelo; Gislason, David; Gulsvik, Amund; Jõgi, Rain; Marinoni, Alessandra; Martínez-Moratalla, Jesús; Pin, Isabelle; Janson, Christer
Citation:
J. Allergy Clin. Immunol. 2006, 117(6):1249-56
Issue Date:
1-Jun-2006
Abstract:
BACKGROUND: The natural history of asthma severity is poorly known. OBJECTIVE: To investigate prognostic factors of asthma severity. METHODS: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). RESULTS: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. CONCLUSION: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. CLINICAL IMPLICATIONS: Our results suggest that the evolution of asthma severity is to a large extent predictable.
Description:
To access publisher full text version of this article. Please click on the hyperlink in Additional Links field
Additional Links:
http://dx.doi.org/10.1016/j.jaci.2006.03.019

Full metadata record

DC FieldValue Language
dc.contributor.authorde Marco, Roberto-
dc.contributor.authorMarcon, Alessandro-
dc.contributor.authorJarvis, Deborah-
dc.contributor.authorAccordini, Simone-
dc.contributor.authorAlmar, Enrique-
dc.contributor.authorBugiani, Massimiliano-
dc.contributor.authorCarolei, Adriana-
dc.contributor.authorCazzoletti, Lucia-
dc.contributor.authorCorsico, Angelo-
dc.contributor.authorGislason, David-
dc.contributor.authorGulsvik, Amund-
dc.contributor.authorJõgi, Rain-
dc.contributor.authorMarinoni, Alessandra-
dc.contributor.authorMartínez-Moratalla, Jesús-
dc.contributor.authorPin, Isabelle-
dc.contributor.authorJanson, Christer-
dc.date.accessioned2006-12-05T14:20:18Z-
dc.date.available2006-12-05T14:20:18Z-
dc.date.issued2006-06-01-
dc.date.submitted2006-12-05-
dc.identifier.citationJ. Allergy Clin. Immunol. 2006, 117(6):1249-56en
dc.identifier.issn0091-6749-
dc.identifier.pmid16750983-
dc.identifier.doi10.1016/j.jaci.2006.03.019-
dc.identifier.otherAAI12-
dc.identifier.urihttp://hdl.handle.net/2336/6356-
dc.descriptionTo access publisher full text version of this article. Please click on the hyperlink in Additional Links fielden
dc.description.abstractBACKGROUND: The natural history of asthma severity is poorly known. OBJECTIVE: To investigate prognostic factors of asthma severity. METHODS: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). RESULTS: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. CONCLUSION: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. CLINICAL IMPLICATIONS: Our results suggest that the evolution of asthma severity is to a large extent predictable.en
dc.language.isoenen
dc.publisherMosbyen
dc.relation.urlhttp://dx.doi.org/10.1016/j.jaci.2006.03.019en
dc.subject.meshAdulten
dc.subject.meshAsthmaen
dc.subject.meshBody Mass Indexen
dc.subject.meshCohort Studiesen
dc.subject.meshEuropeen
dc.subject.meshFemaleen
dc.subject.meshFollow-Up Studiesen
dc.subject.meshHumansen
dc.subject.meshInternationalityen
dc.subject.meshMaleen
dc.subject.meshMulticenter Studiesen
dc.subject.meshPrognosisen
dc.subject.meshProspective Studiesen
dc.subject.meshResearch Support, Non-U.S. Gov'ten
dc.subject.meshSeverity of Illness Indexen
dc.titlePrognostic factors of asthma severity: a 9-year international prospective cohort studyen
dc.typeArticleen
dc.format.digYES-
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