Differences between asthma exacerbations and poor asthma control

Reddel, Helen K.; Ware, Sandra; Marks, Guy B.; Salome, Cheryl M.; Jenkins, Christine; Woolcock, Ann J.

doi:10.1016/s0140-6736(98)06128-5

Cited by 254 publications

(183 citation statements)

References 28 publications

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“…Although a considerable proportion of asthma morbidity, mortality and health costs can be attributed to exacerbations, objective criteria for defining such events are lacking, and it is sometimes difficult to differentiate an exacerbation from poor asthma control [2][3][4][5]. The lack of a universally accepted definition of an exacerbation creates difficulties in the interpretation of clinical research and trial results, with the exception of severe asthma, exacerbations being defined fairly obviously [6].…”

Section: Definitionsmentioning

confidence: 99%

Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers: Figure 1–

Xepapadaki¹,

Papadopoulos²

2010

Eur Respir J

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Respiratory infections have been implicated in the origin and exacerbation of asthma in a variety of ways; however, systemisation of this knowledge in a way helpful for disease management remains suboptimal.Several conceptual issues need to be taken into account: the fact that the effects of an infection may vary according to genetic background, the current immune status of the host, and parallel environmental stimuli, in addition to the particular infectious agent itself. Moreover, childhood is a very special period because of the continuous processes taking place, such as neural, immune and respiratory maturation.Epidemiological studies have convincingly demonstrated that the majority of asthma exacerbations, in both adults and children, follow viral upper respiratory tract infections. Asthma exacerbations are still often unresponsive to current asthma treatment, and new therapeutic approaches are required.This review presents current knowledge on the associations between infection and exacerbation of established asthma with respect to definitions, epidemiology, mechanisms and treatment.

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Section: Definitionsmentioning

confidence: 99%

Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers: Figure 1–

Xepapadaki¹,

Papadopoulos²

2010

Eur Respir J

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“…[1][2][3][4] However, there is still considerable disagreement on several aspects of asthma monitoring, from overall usefulness to standardization of graphic data rendering. 7,11,[15][16][17] Asthma home monitoring has been applied in 4 settings: self-management, in association with an asthma action plan [5][6][7] ; management of asthma patients by clinicians, including diagnosis refining, and retrospective therapy assessment [8][9][10][11] ; clinical trials and clinical research, where it is one of the most widely used investigation tools and a valuable source of information [18][19][20][21][22] ; and occupational asthma. [23][24] Our study dealt with retrospective monitoring of patients with poorly controlled persistent asthma and no previous experience of home monitoring, in a clinical management setting.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] On the other hand, retrospective monitoring allows fine diagnosis assessment and punctual therapy evaluation. [8][9][10][11] However, its application to routine clinical practice poses several still controversial questions: particularly, to whom and exactly when should retrospective monitoring be applied? For how long?…”

Section: Introductionmentioning

confidence: 99%

Retrospective Monitoring in the Management of Persistent Asthma

et al. 2011

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BACKGROUND: There is still considerable disagreement on several aspects of monitoring asthma with symptom score and peak expiratory flow (PEF). OBJECTIVE: To investigate patient adherence to a retrospective diary-card monitoring method in patients with poorly controlled persistent asthma, in a clinical management setting; to develop improved methods for fast manual entry data into a computer; and to generate real-time informative graphs of the data. METHODS: In 115 consecutive adult patients we applied a diary-card monitoring method in which the patient records symptom score and PEF. We analyzed the diary cards of 84 patients. We used SigmaPlot software to graph the data, and linear regression to analyze the relationship between days of expected diary-card completion and days of actual correct diary-card completion (completed entries). RE-SULTS: Linear regression gave an overall correlation coefficient (r 2 ) of 0.65. Surprisingly, the r 2 values in the patients with mild, moderate, and severe asthma were 0.24, 0.44, and 0.99, respectively, revealing a striking correlation between adherence and severity. Moreover, when we arbitrarily set 75% as the minimum acceptable rate of days of completed diary-card entries, 68% of the patients were in the over-75% category. Remarkably, 100% of the patients with severe asthma were above the 75% cut-off. The graphing method we tested proved user-friendly, flexible, and quick, allowing computerized processing of 30 days of data sets in 5 min, and generation of high-quality selfexplanatory graphs that facilitate rapid management decision making via visual pattern recognition. CONCLUSIONS: In a clinical setting, retrospective monitoring of patients with moderate and severe persistent asthma by symptom score and PEF is feasible, and patient adherence appears to be good, particularly in patients with severe asthma. We recommend a lower priority on retrospective monitoring in patients with mild persistent asthma. Monitoring should be carried out according to a definite follow-up protocol. Improving the quality and standardization of the monitoring graph is a priority.

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“…For the duration of the study, it was not possible to attribute exacerbations to specific triggers, such as infections or allergens, although triggers may vary in their effect on airway function. During regular ICS treatment, a greater proportion of exacerbations may represent infection-induced neutrophilic inflammation unresponsive to ICS [21], and may influence airway structure in a different manner to exacerbations during a period of long-term poor asthma control without regular ICS, with a greater frequency of eosinophilic inflammatory events. Conversely, however, neutrophilic inflammation has been proposed to be more deleterious to airway structure [22].…”

Section: Discussionmentioning

confidence: 99%

Severe exacerbations predict excess lung function decline in asthma

Willsie¹

2009

Yearbook of Pulmonary Disease

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Severe asthma exacerbations are periods of intense airway inflammation that have been hypothesised to contribute to structural changes in the airways. If so, accelerated lung function decline over time should be more prevalent in adult patients with asthma who have frequent exacerbations than those without, but to date this has not been demonstrated.A cohort study was performed in order to investigate the effect of severe exacerbations on the progression of airway obstruction in 93 nonsmoking asthmatics with moderate-to-severe disease prior to treatment with inhaled corticosteroids. Subjects were followed for o5 yrs (median followup 11 yrs).In total, 56 (60.2%) subjects experienced at least one severe exacerbation (median rate 0.10?yr -1 ). Oral corticosteroid use and more severe airway obstruction at baseline were associated with a higher exacerbation rate. Independent of these variables, asthma patients with frequent exacerbations had a significantly larger annual decline in forced expiratory volume in one second (FEV1; median difference (95% confidence interval) 16.9 (1.5-32.2) mL?yr -1 ). Exacerbation rate significantly predicted an excess decline in FEV1, such that one severe exacerbation per year was associated with a 30.2 mL greater annual decline in FEV1.These data support the hypothesis that exacerbations, indicating intermittent periods of worsening airway inflammation, are associated with excess lung function decline in asthma.

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Differences between asthma exacerbations and poor asthma control

Cited by 254 publications

References 28 publications

Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers: Figure 1–

Childhood asthma and infection: virus-induced exacerbations as determinants and modifiers: Figure 1–

Retrospective Monitoring in the Management of Persistent Asthma

Severe exacerbations predict excess lung function decline in asthma

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