Risk factors for an exacerbation-prone asthma phenotype

May 20, 2012

A number of specific risk factors are associated with an exacerbation-prone phenotype of severe asthma, according to a new study from researchers in Sweden.

The results will be presented at the ATS 2012 International Conference in San Francisco.

"Acute exacerbations are a major source of morbidity and mortality in asthma," said lead author Maciek Kupczyk, MD, PhD, a researcher at the Karolinska Institutet in Stockholm "In children, the costs of are three times higher in exacerbators as compared to those patients who did not experience any attacks. Exacerbations are a prominent feature of poorly controlled and severe asthma, and even in patients with mild disease, the rates of severe exacerbations are high."

"Recent ATS/ERS guideline point out that exacerbations constitute the greatest risk to patients, are the major cause of stress and anxiety to patients and their families, and generate the greatest cost to the ," continued Dr. Kupczyk. "In our clinical practice, we have recognized a subgroup of asthma patients that experience a higher rate of exacerbations. In contrast to (COPD), the phenotype of frequent exacerbators has not been clearly characterized in ."

The study enrolled 93 patients with severe asthma and 76 patients with mild-to-moderate asthma who were followed for one year. Patients with at least one despite high-dose inhaled corticosteroid treatment and in the year prior to enrollment in the study were considered to have severe asthma.

A total of 122 exacerbations were recorded during follow-up, including 104 that occurred in 52 patients with severe asthma and 18 that occurred in 16 patients with moderate asthma. Frequent exacerbations occurred only in the group.

Frequent exacerbators used significantly higher doses of inhaled and oral glucocorticosteroids, had worse asthma control, and had higher C-reactive and higher sputum eosinophils at baseline as compared with non-frequent exacerbators. A significantly faster decline in FEV1/FVC ratio was also seen in frequent exacerbators.

When frequent exacerbations were defined as two or more events per year, Juniper asthma control questionnaire (ACQ) score, sputum eosinophils ≥2%, smoking history, lower quality of life, and forced expiratory volume (FEV1) ≤70% were associated with the development of exacerbations. When frequent exacerbations were defined as three or more events per year, body mass index >25, quality of life, smoking, and Juniper ACQ score were associated with the development of exacerbations.

"Exacerbations are important events in the natural history of asthma that is not well controlled," said Dr. Kupczyk. The implications of these flare-ups include an increased risk of mortality, low health status, decreased quality of life, and extensive utilization of health care resources."

"In this study we detail the characteristics of frequent exacerbators' phenotype based on medical history, physiological variables and biomarkers," said Dr. Kupczyk. "The ability to identify patients at greatest risk for future exacerbations is vital for developing effective preventive strategies, reducing health care costs, and achieving good .

"Appropriate long term management strategies using a personalized medicine approach, coupled with improved compliance, should reduce mortality and morbidity associated with exacerbations," Dr. Kupczyk concluded. "However, further studies are needed to clarify which treatment option is optimal in frequent exacerbators."

Explore further: Low vitamin D levels do not increase the risk of chronic obstructive pulmonary disease

More information: "Identification Of Risk Factors For Frequent Exacerbations In Severe Asthma" (Session A92, Sunday, May 20, Room 2005-2007, Moscone Center; Abstract 31646)

Related Stories

Low vitamin D levels do not increase the risk of chronic obstructive pulmonary disease

November 4, 2011
Vitamin D levels are not related to acute exacerbations of chronic obstructive pulmonary disease (AECOPD) in patients with severe COPD, according to a large prospective cohort study involving 973 North American patients. ...

Assessment of COPD exacerbation severity with the COPD Assessment Test

January 27, 2012
Exacerbation severity in patients with chronic obstructive pulmonary disease (COPD) can be reliably assessed with the COPD Assessment Test (CAT), according to a new study from the UK.

HRT therapy appears to increase risk of hospitalization from severe asthma attacks

September 27, 2011
Women taking postmenopausal hormone replacement therapy (HRT) may have an increased risk of severe asthma attacks requiring hospitalisation, scientists warn.

Postponing care can result in serious consequences for asthma patients

May 16, 2011
Waiting to seek emergency medical care for asthma exacerbations can result in worse outcomes, including hospitalization, according to a study conducted by researchers from New York. Patients who delay regular medical care ...

Poor asthma control prevalent in the united states

February 28, 2012
(HealthDay) -- Many patients with asthma who do not use controller medications have persistent disease, and among those patients who do use controller medications, few have well-controlled disease, according to a study published ...

Recommended for you

Australian researchers in peanut allergy breakthrough

August 17, 2017
Australian researchers have reported a major breakthrough in the relief of deadly peanut allergy with the discovery of a long-lasting treatment they say offers hope that a cure will soon be possible.

Genetic variants found to play key role in human immune system

August 16, 2017
It is widely recognized that people respond differently to infections. This can partially be explained by genetics, shows a new study published today in Nature Communications by an international collaboration of researchers ...

Study identifies a new way to prevent a deadly fungal infection spreading to the brain

August 16, 2017
Research led by the University of Birmingham has discovered a way to stop a deadly fungus from 'hijacking' the body's immune system and spreading to the brain.

Biophysics explains how immune cells kill bacteria

August 16, 2017
(Tokyo, August 16) A new data analysis technique, moving subtrajectory analysis, designed by researchers at Tokyo Institute of Technology, defines the dynamics and kinetics of key molecules in the immune response to an infection. ...

How a nutrient, glutamine, can control gene programs in cells

August 15, 2017
The 200 different types of cells in the body all start with the same DNA genome. To differentiate into families of bone cells, muscle cells, blood cells, neurons and the rest, differing gene programs have to be turned on ...

Scientists identify gene that controls immune response to chronic viral infections

August 15, 2017
For nearly 20 years, Tatyana Golovkina, PhD, a microbiologist, geneticist and immunologist at the University of Chicago, has been working on a particularly thorny problem: Why are some people and animals able to fend off ...

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.