Characterization of the severe asthma phenotype by the National Heart, Lung, and Blood Institute's Severe Asthma Research Program

Abstract

Background-Severe asthma causes the majority of asthma morbidity. Understanding mechanisms that contribute to the development of severe disease is important.

Effect of Continuity of Care on Emergency Department Visits in Elderly Patients with Asthma in Taiwan

“…50 Second, the claims data did not include the results of clinical data, such as peak expiratory flow or forced expiratory volume, to define disease severity and health status. 38,51 Therefore, we referred to previous studies to adopt the frequency of ambulatory visits for asthma, 25,26,30 hospitalization, 24 and ED visits 22,24,25 as a proxy for asthma severity, and we used CCI as a proxy indicator to present each patient's health status. 21,22,52 Third, we could not obtain patients' educational level or household income, and this may affect the measurement of COC and outcomes.…”

“…The total number of physician visits (N) and the number of visits to a given physician (n i ) include ambulatory claims (including clinic or hospital physician visits) in the principal diagnosis (ICD-9-CM code 493.xx). We calculated COCI 37 Patients' educational level or household income may affect health care outcomes 6,23,38 ; the NHI claims data set does not provide this information. Hence, insurance premiums were used as a proxy for socioeconomic status.…”

Asthma-related comorbidities

“…The prevalence of comorbidities is particularly high in severe asthma, and these conditions can be quite detrimental to asthma control in such individuals [1,2,[190][191][192][193]. In the National Heart, Lung, and Blood Institute cohort, Moore et al found an increase in aspirin intolerance in severe compared with nonsevere asthma, as well as an increase in GERD (41 vs 12-16%), a history of sinusitis (54 vs 33-37%) and history of pneumonia (63 vs 35-36%) [190].…”

“…In the National Heart, Lung, and Blood Institute cohort, Moore et al found an increase in aspirin intolerance in severe compared with nonsevere asthma, as well as an increase in GERD (41 vs 12-16%), a history of sinusitis (54 vs 33-37%) and history of pneumonia (63 vs 35-36%) [190]. In another analysis of this Severe Asthma Research program cohort, Wenzel et al reported that severe asthma is associated with obesity, aspirin sensitivity and sinusitis in females, and inversely associated with atopy [191].…”

Potential Role of Serum Periostin in the Early Detection of Bronchial Asthma in Children

“…Тем не менее в ряде случаев не удается эффек-тивно контролировать симптомы бронхиальной астмы, несмотря на высокие дозы ингаляционных ГКС в сочета-нии с длительно действующими ␤-агонистами (long-acting ␤ 2 -agonists, LABA) или даже применение системных ГКС [20]. Среди взрослых пациентов примерно в 5-10% слу-чаев выявляется рефрактерная, плохо контролируемая астма, несмотря на максимальную ингаляционную тера-пию [21], и на нее приходится значительная доля потре-бления ресурсов здравоохранения [22].…”