Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents

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• 作者：Jacqueline A. Pongracic ; MD^a ; ^{jpongracic@luriechildrens.org" class="auth_mail" title="E-mail the corresponding author} ; Rebecca Z. Krouse ; MS^b ; Denise C. Babineau ; MS ; PhD^b ; Edward M. Zoratti ; MD^c ; Robyn T. Cohen ; MD ; MPH^d ; Robert A. Wood ; MD^e ; Gurjit K. Khurana Hershey ; MD ; PhD^f ; Carolyn M. Kercsmar ; MD^f ; Rebecca S. Gruchalla ; MD ; PhD^g ; Meyer Kattan ; MD^h ; Stephen J. Teach ; MD ; MPHⁱ ; Christine C. Johnson ; PhD ; MPH^c ; Leonard B. Bacharier ; MD^j ; James E. Gern ; MD^k ; Steven M. Sigelman ; RN ; MHA^l ; Peter J. Gergen ; MD ; MPH^l ; Alkis Togias ; MD^l ; Cynthia M. Visness ; PhD^b ; William W. Busse ; MD^k ; Andrew H. Liu ; MD^m
• 关键词：Child ; asthma ; inner-city asthma ; asthma phenotype ; asthma morbidity ; asthma severity ; asthma exacerbations ; pulmonary function ; rhinitis ; allergen sensitization ; IgE
• 刊名：Journal of Allergy and Clinical Immunology
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：138
• 期：4
• 页码：1030-1041
• 全文大小：779 K

文摘

Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated.

Objective

We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma.

Methods

Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models.

Results

Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV₁ bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy.

Conclusions

Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.