Asthma outcomes: Exacerbations

Abstract

Background The goals of asthma treatment include preventing recurrent exacerbations. Yet there is no consensus about the terminology for describing or defining “exacerbation,” or about how to characterize an episode’s severity. Objective National Institutes of Health (NIH) institutes and other federal agencies convened an expert group to propose how asthma exacerbation should be assessed as a standardized asthma outcome in future asthma clinical research studies. Methods We utilized comprehensive literature reviews and expert opinion to compile a list of asthma exacerbation outcomes, and classified them as either core (required in future studies), supplemental (used according to study aims and standardized), or emerging (requiring validation and standardization). This work was discussed at an NIH-organized workshop in March 2010 and finalized in September 2011. Results No dominant definition of “exacerbation” was found. The most widely used definitions included 3 components, all related to treatment, rather than symptoms: (1) systemic use of corticosteroids, (2) asthma-specific emergency department visits or hospitalization, and (3) use of short-acting β-agonists (SABAs) as quick-relief (sometimes referred to as “rescue” or “reliever”) medications. Conclusions The working group participants propose that the definition of “asthma exacerbation” be “a worsening of asthma requiring the use of systemic corticosteroids to prevent a serious outcome.” As core outcomes, they propose inclusion and separate reporting of several essential variables of an exacerbation. Further, they propose the development of a standardized, component-based definition of “exacerbation” with clear thresholds of severity for each component.

Activin-A is overexpressed in severe asthma and is implicated in angiogenic processes

“…E1). Asthma exacerbations were defined as episodes of severe symptom deterioration and elevated rescue medication usage that required the administration of systemic corticosteroids or an elevated dosage for ⩾3 days [37]. Prior to participation in the study, all subjects provided informed written consent and the protocol was approved by the hospital's research ethics committee and the Greek National Organization for Medicines.…”

Parental Numeracy and Asthma Exacerbations in Puerto Rican Children

“…The child's parents completed a questionnaire used in the Genetics of Asthma in Costa Rica Study, which was slightly modifi ed from one used in the Collaborative Study of the Genetics of Asthma. 18 This questionnaire was used to obtain information about the child's general and respiratory health, sociodemographic characteristics, family history, (current) exposure to secondhand tobacco smoke, in utero smoking, use of inhaled corticosteroids (ICSs) in the previous 6 months, and asthma outcomes (including information about severe asthma exacerbations 19 and core measures of asthma exacerbations 20 [see later description]). Parental numeracy was measured in one of the parents using a slightly modifi ed version of the Asthma Numeracy Questionnaire (ANQ), a four-item validated test that uses arithmetic or percentage-based statements or questions derived from the National Asthma Education and Prevention Program guidelines that patients with asthma might encounter during a clinic visit.…”

“…The proportion of mothers who answered the modifi ed ANQ the modifi ed ANQ ( Fig 1 ). Our primary outcomes were severe asthma exacerbations ( Ն 1 course of systemic steroids for asthma in the prior year), 19 core measures of asthma exacerbations ( Ն 1 visit to the ED or urgent care for asthma in the prior year and Ն 1 hospitalization for asthma in the prior year), 20 and measures of lung function (FEV 1 and FEV 1 /FVC).…”

Cost-effectiveness and Budget Impact of Routine Use of Fractional Exhaled Nitric Oxide Monitoring for the Management of Adult Asthma Patients in Spain

“…Management and prevention of asthma exacerbations is a key focus of asthma care [31]. Reduced exacerbation rates and improved symptom control without increasing overall use of ICS were recently demonstrated when a FeNO-guided anti-inflammatory treatment algorithm was assessed and compared with standard care [15].…”