High ACT score is not sufficient to reduce the risk of asthma exacerbations in asthma with low lung function

Kwon, Jae-Woo; Jung, Hee-Won; Kim, Sae-Hoon; Chang, Yoon-Seok; Cho, You Sook; Nahm, Dong-Ho; Jang, An‐Soo; Park, Jung-Won; Yoon, Ho Joo; Cho, Sang Heon; Cho, Young-Joo; Choi, Byoung Whui; Moon, Hee‐Bom; Kim, Tae‐Bum; investigators, Corea

doi:10.1016/j.rmed.2019.02.010

Cited by 9 publications

(5 citation statements)

References 32 publications

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“…Un mal control de los síntomas de asma se asocia con mayor riesgo de exacerbaciones, de hospitalización y de uso de GCO 37 . Además, la presencia de obstrucción bronquial es un factor de riesgo independiente para sufrir exacerbaciones en el futuro, incluso si el ACT es ≥ 20 38 . La reversibilidad en la prueba broncodilatadora también ha sido reportada como factor que aumenta el riesgo de exacerbaciones 39 .…”

Section: Seguimiento Del Asma Graveunclassified

Documento de consenso de asma grave en adultos. Actualización 2022

Álvarez-Gutiérrez

Aparicio

Maldonado

et al. 2022

Open Respiratory Archives

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Section: Seguimiento Del Asma Graveunclassified

Documento de consenso de asma grave en adultos. Actualización 2022

Álvarez-Gutiérrez

Aparicio

Maldonado

et al. 2022

Open Respiratory Archives

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“…Pulmonary function is another aspect of clinical outcomes for the evaluation of airway remodeling. Previous reviews have claimed an association between spirometry and treatment outcome [11][12][13]32 ; however, a discrepancy was still observed in several studies 9,33 . Patients with significant symptoms might have preserved FEV 1 without fixed airway obstruction in real-world practice.…”

Section: Discussionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

“…Pulmonary function also provides clinicians with another aspect of disease control; however, the discrepancy between asthma control scores and pulmonary function tests existed in previous studies 9,10 . Spirometry is not well-correlated with symptoms, although low forced expiratory volume in one second (FEV 1 ) is associated with the risk of exacerbation [11][12][13] . Mostly, patients presented suboptimal asthma control but preserved FEV1 14 .Oscillometry measures respiratory mechanics at different frequencies, such as airway resistance and reactance, to evaluate subtle changes in the small airway, inhomogeneity, and compliance of the peripheral lung.…”

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confidence: 99%

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Assessing the prognostic value of respiratory oscillometry in patients with difficult-to-treat asthma

Shen

Hsieh

Huang

et al. 2023

Sci Rep

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Respiratory oscillometry is widely explored in asthma management; however, there is currently no consensus on its routine work-up in patients with difficult-to-treat asthma. We conducted a retrospective, cross-sectional study involving patients with difficult-to-treat asthma at Asia University Hospital between January 2017 and October 2020. We aimed to correlate clinical significance of respiratory oscillometry and asthma treatment outcomes including symptoms control and exacerbation in patients with difficult-to-treat asthma. Among the 69 patients enrolled in the study, a total of 26.1% of the patients experienced at least one severe or two moderate exacerbations. Patients with ACT < 20 presented a higher prevalence of higher frequency-dependent resistance (FDR; the difference in resistance at 5 Hz and 20 Hz) and frequency of resonance (Fres) than those with ACT ≥ 20. In the multivariable analysis, comorbidities, COPD or allergic rhinitis, and FDR were independent factors in increasing the odds ratio in poorly controlled asthma. (FDR ≥ 0.10 vs. < 0.10, adjusted ORR = 5.05, P = 0.037) There was a higher proportion of frequent exacerbations in patients with higher FDR (FDR ≥ 0.10 vs. < 0.10 = 30.0%:20.7%), but IOS parameters failed to predict frequent exacerbations on further analysis. FDR may be a potential clinical parameter for predicting symptom control in patients with difficult-to-treat asthma.

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“…Moreover, their findings show differences in the response to treatment, which appear to reflect the pharmacological properties (e.g., lung residence time, systemic absorption, glucocorticoid receptor affinity) and therapeutic index of different corticosteroids [ 22 ]. The choice of ICS can therefore influence long-term outcomes, including exacerbation risk, which may be crucial for individuals at higher risk despite achieving a comparable level of symptom control [ 23 ].…”

Section: Introductionmentioning

confidence: 99%

Understanding the Clinical Implications of Individual Patient Characteristics and Treatment Choice on the Risk of Exacerbation in Asthma Patients with Moderate–Severe Symptoms

Singh,

Oosterholt,

Pavord

et al. 2023

Adv Ther

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Introduction The assessment of future risk has become an important feature in the management of patients with asthma. However, the contribution of patient-specific characteristics and treatment choices to the risk of exacerbation is poorly understood. Here we evaluated the effect of interindividual baseline differences on the risk of exacerbation and treatment performance in patients receiving regular maintenance doses of inhaled corticosteroids (ICS) or ICS/long-acting beta-agonists (LABA) combination therapy. Methods Exacerbations and changes to asthma symptoms 5-item Asthma Control Questionnaire (ACQ-5) were simulated over a 12-month period using a time-to-event and a longitudinal model developed from phase III/IV studies in patients with moderate–severe asthma ( N = 16,282). Simulations were implemented to explore treatment performance across different scenarios, including randomised designs and real-world settings. Treatment options included regular dosing with ICS monotherapy [fluticasone propionate (FP)] and combination therapy [fluticasone propionate/salmeterol (FP/SAL) or budesonide/formoterol (BUD/FOR)]. Exacerbation rate was analysed using the log-rank test. The cumulative incidence of events was summarised stratified by treatment. Results Being a woman, smoker, having higher baseline ACQ-5 and body mass index (BMI) and lower forced expiratory volume in the first second (FEV 1 ) are associated with increased exacerbation risk ( p < 0.01). This risk is bigger in winter because of the seasonal variation effect. Across the different scenarios, the use of FP/SAL resulted in a 10% lower annual incidence of exacerbations relative to FP or regular dosing BUD/FOR, independently of baseline characteristics. Similar differences in the annual incidence of exacerbations were also observed between treatments in obese patients (BMI ≥ 25–35 kg/m 2 ) ( p < 0.01) and in patients who do not achieve symptom control on FP monotherapy. Conclusions Individual baseline characteristics and treatment choices affect future risk. Achieving comparable levels of symptom control whilst on treatment does not imply comparable risk reduction, as shown by the lower exacerbation rates in FP/SAL vs. BUD/FOR-treated patients. These factors should be considered as a basis for personalised clinical management of patients with moderate–severe asthma. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-023-02590-2.

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High ACT score is not sufficient to reduce the risk of asthma exacerbations in asthma with low lung function

Cited by 9 publications

References 32 publications

Documento de consenso de asma grave en adultos. Actualización 2022

Documento de consenso de asma grave en adultos. Actualización 2022

Assessing the prognostic value of respiratory oscillometry in patients with difficult-to-treat asthma

Understanding the Clinical Implications of Individual Patient Characteristics and Treatment Choice on the Risk of Exacerbation in Asthma Patients with Moderate–Severe Symptoms

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