Abstract
Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.
| Original language | English |
|---|---|
| Pages (from-to) | 1249-1256 |
| Number of pages | 8 |
| Journal | Journal of Allergy and Clinical Immunology |
| Volume | 117 |
| Issue number | 6 |
| DOIs | |
| Publication status | Published - Jun 2006 |
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Keywords
- Asthma
- asthma remission
- body mass index
- ECRHS
- European Community Respiratory Health Survey
- Global Initiative for Asthma (GINA) guidelines
- IgE
- prognostic factors
- prospective cohort study
- severity
ASJC Scopus subject areas
- Immunology and Allergy
- Immunology
Cite this
Prognostic factors of asthma severity : A 9-year international prospective cohort study. / de Marco, Roberto; Marcon, Alessandro; Jarvis, Deborah; Accordini, Simone; Almar, Enrique; Bugiani, Massimiliano; Carolei, Adriana; Cazzoletti, Lucia; Corsico, Angelo; Gislason, David; Gulsvik, Amund; Jõgi, Rain; Marinoni, Alessandra; Martínez-Moratalla, Jesús; Pin, Isabelle; Janson, Christer.
In: Journal of Allergy and Clinical Immunology, Vol. 117, No. 6, 06.2006, p. 1249-1256.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prognostic factors of asthma severity
T2 - A 9-year international prospective cohort study
AU - de Marco, Roberto
AU - Marcon, Alessandro
AU - Jarvis, Deborah
AU - Accordini, Simone
AU - Almar, Enrique
AU - Bugiani, Massimiliano
AU - Carolei, Adriana
AU - Cazzoletti, Lucia
AU - Corsico, Angelo
AU - Gislason, David
AU - Gulsvik, Amund
AU - Jõgi, Rain
AU - Marinoni, Alessandra
AU - Martínez-Moratalla, Jesús
AU - Pin, Isabelle
AU - Janson, Christer
PY - 2006/6
Y1 - 2006/6
N2 - Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.
AB - Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.
KW - Asthma
KW - asthma remission
KW - body mass index
KW - ECRHS
KW - European Community Respiratory Health Survey
KW - Global Initiative for Asthma (GINA) guidelines
KW - IgE
KW - prognostic factors
KW - prospective cohort study
KW - severity
UR - http://www.scopus.com/inward/record.url?scp=33646918354&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33646918354&partnerID=8YFLogxK
U2 - 10.1016/j.jaci.2006.03.019
DO - 10.1016/j.jaci.2006.03.019
M3 - Article
C2 - 16750983
AN - SCOPUS:33646918354
VL - 117
SP - 1249
EP - 1256
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
SN - 0091-6749
IS - 6
ER -