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 two prior NIAID Inner City Asthma Consortium trials. Objective We 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 PROSE (Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations) study. We characterized those inner-city children with and without asthma exacerbations in the fall periods 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<0.001, AUC 0.76) and the GBT + omalizumab group (p<0.01, AUC 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percent and number, and higher treatment step were associated with those who had an exacerbation compared to 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, 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.

Measurement of fractional exhaled nitric oxide in real-world clinical practice alters asthma treatment decisions

“…The addition of FeNO monitoring has been shown to help identify patients who might be at risk for future exacerbations, including those who might not be recognized by conventional clinical methods. 16,18,40 In contrast, low levels of FeNO (≤25 ppb) could suggest that inflammation is being adequately controlled and that corticosteroid doses can be stepped down. Alternatively, low FeNO values can suggest the absence of corticosteroid-sensitive type 2 inflammation or a misdiagnosis of asthma.…”

Asthma across the lifespan: Time for a paradigm shift

“…SAEPI was developed and validated by the NIAID ICAC to identify children at risk for an asthma exacerbation. 22,23 An exacerbation in the prior season and low pulmonary function are predictors of an asthma exacerbation at any time of the year, whereas measures like increased numbers of positive allergen skin test responses, increased ICS doses, increased exhaled nitric oxide levels, and increased blood eosinophil counts and total and specific IgE levels might be useful for predicting a seasonal asthma exacerbation, especially during the fall season. 22 The Preventative Omalizumab or…”

Boehringer‐Ingelheim Satellite Symposium Choosing the Right Controller Therapy in Pediatric Patients with Asthma

“…Current therapy will likely reduce the risk of an asthma exacerbation in most but not all patients. The Seasonal Asthma Exacerbation Predictive Index (SAEPI) was also developed and validated by the NIAID ICAC to identify children at risk for an asthma exacerbation . An exacerbation in the prior season and low pulmonary function are predictors of an asthma exacerbation at any time of the year, while measures such as an increased number of allergen skin test positives, increased ICS dose, increased exhaled nitric oxide, as well as increased levels of blood eosinophils, total and specific IgE may be useful for predicting a seasonal asthma exacerbation, especially during the fall season and developing prevention strategies …”