Prediction of unsuccessful treatment in patients with severe acute asthma

Goodacre, Steve; Bradburn, Michael; Cohen, Judith; Gray, Alasdair; Benger, Jonathan; Coats, Timothy J

doi:10.1136/emermed-2013-203046

Cited by 8 publications

(5 citation statements)

References 13 publications

(13 reference statements)

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“…One of the recent study concluded that pre-dose PEFR, can work as an alternative primary lung function endpoint for trials in adolescent and adult patients with asthma. They demonstrated a strong association between pre-dose FEV1 and pre-dose PEFR (25).…”

Section: 3 and 4)mentioning

confidence: 96%

PEFR monitoring can better predict asthma exacerbation as compared to monitoring by symptoms: prospective cohort study

Gupta¹,

.²,

Kumar

2023

Preprint

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Background: GINA guidelines suggest to use PEFR monitoring to assess response to treatment, to identify triggers for exacerbation and to have a baseline value for action plan (especially for the poor perceivers). In comparison to adults, there are less evidence in support of the routine use of PEFR recording for the diagnosis and monitoring level of control of asthma in children. Objective: This study was conducted with objective to assess the effect of PEFR monitoring on numbers of exacerbations in comparison to monitoring by symptoms in asthma. Material and Methods: This was a prospective cohort study done for a in Department of Pediatrics and Respiratory medicine, of a tertiary care hospital, North India. Prior to recruitment ethical approval and informed consent/assent was taken. Study subjects were children with partial and uncontrolled asthma aged 5-12 years of age. Patients were divided into two groups on their first visit by using random allocation number. In Group “A” monitoring was done with symptoms only, while in Group “B” monitoring was done by symptoms and PEFR. Number of exacerbations during study period was noted. At baseline and follow up, CACT score was calculated. Spirometry was done at the end of 3 months. Result: Group B had statistically significant lesser exacerbation during study period as compared to Group A (OR=0.11; 95%CI=0.01-0.57; p value=0.003). Conclusion: PEFR based monitoring can be used as a potential tool for aborting or decreasing the severity of episodes of exacerbations of asthma especially in resource limited areas.

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Section: 3 and 4)mentioning

confidence: 96%

PEFR monitoring can better predict asthma exacerbation as compared to monitoring by symptoms: prospective cohort study

Gupta¹,

.²,

Kumar

2023

Preprint

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“…β-agonists are prescribed and given to treat airflow obstruction rapidly, while in case the patients didn't respond to β-agonists or patients exhibited moderate or severe asthma exacerbations, anticholinergics/ systemic corticosteroids are given early for treatment [13]. Inhaled βagonists and inhaled corticosteroids (ICSs) are effective in treating allergic asthma, while systematic corticosteroids (SCS) are needed to treat the infected patients [30].…”

Section: Treatmentmentioning

confidence: 99%

Acute Asthma, Prognosis, and Treatment

Hassan¹

2021

IJMBS

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Background: Asthma is a major health problem affecting all ages that increase the mortality rate worldwide. Early detection of its signs and symptoms are essential to control and maintain the disease and effective treatments are administrated, such as; ?-agonists and corticosteroids. The current review is about acute asthma, prognosis, and treatment. Methods: Scientific articles that linked to the present topic were obtained using an online searching process. The searching process included different scientific websites such as Google Scholar and PubMed. We obtained 16 articles that matched with the current subject and written in English. Of those 16 articles, 4 were excluded as they published before 2000, or mayn’t focusing on the present topic, or written in a language other than English; therefore, only 12 papers were included, and they were published till 2020. Results: Articles were selected according to the inclusion criteria that we selected, and then the discussion of the subject was performed under the main titles. Conclusion: Asthma is one of the most chronic inflammatory disease that increased the mortality rate worldwide. Asthma could affect 300 million individuals and account for one death among 250 death cases. All patients admitted with asthma exacerbation should be assessed promptly through detecting and recognition worsening signs and symptoms. The initial treatment includes oxygen administration, Short-acting ?-agonist, and systematic corticosteroids. Decreasing the severity of asthma exacerbations by improving daily therapy for asthma, controlling environmental triggers, and increasing patient education toward asthma risks and how they recognize its symptoms and seek for health care help. Keywords: Asthma exacerbations, ?-agonist, corticosteroids, differential diagnosis, fatal and non-fatal asthma.

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“…So far there have been no recognized indicators to predict the treatment response and prognosis for asthma exacerbation. In 2013, a large multicenter clinical study on severe asthma exacerbation led by Goodacre et al (67) demonstrated that, PEF rate variability and heart rate at baseline and 2 hours after treatment, and comorbidity with other severe diseases, are independent predictors of treatment failure. In 2016, a study recruiting 973 asthmatic children referred to emergency departments, identified treatment failure in 17% of all cases.…”

Section: Prognosismentioning

confidence: 99%

Chinese expert consensus-based guideline on assessment and management of asthma exacerbation

et al. 2019

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The goal of management for bronchial asthma (referred to as asthma below) is to achieve overall control of the condition, including control of current symptoms and reduction on future risks. Asthma exacerbation as one of critical component of the future risks (1,2), may induce a variety of harms to the host, necessitate additional use of medical resources, impose serious socioeconomic burdens, and represent a significant cause of asthma-related disability and mortality (3). As such, prevention and reduction of the asthma exacerbation are of important relevance in improving the overall control of asthma (2-5).In diagnosing and treating asthma exacerbation, the expertise of clinicians in Chinese hospitals of varied levels has currently been compromised by less standard practicing due to a number of subjective or objective factors. This also results in increased medical cost (3). To standardize the practicing, renew the understandings on diagnosis and treatment, and improve the care for asthma exacerbation, the China Asthma Alliance (CAA) has developed this consensus document based on in-depth discussion among a summoned panel of Chinese experts in related fields, with reference to relevant international guidelines (1,6,7) and focused articles appearing within and outside the country in the past few years. The document is desired to offer guidance and evidence for diagnosis, treatment, prevention and management of asthma exacerbation in clinical settings, as well as related studies. DefinitionAsthma exacerbation is defined as sudden onset of symptoms like wheezing, shortness of breath, cough and chest tightness, or worsening of the current symptoms, typically associated with dyspnea and characterized by reduced expiratory flow, and usually requires adjustment of medications (1,6,7).Although sometimes it can be an initial manifestation, asthma exacerbation more likely occurs in patients with confirmed asthma, and in most of times, is triggered by exposure to allergens or irritants, respiratory infections or poor patient adherence to controller medications (5,7), despite unclear predisposing factors in fewer patients. Occasionally, severe exacerbation may be seen in mild or well-controlled asthma (8,9).

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Prediction of unsuccessful treatment in patients with severe acute asthma

Abstract: PEFR, heart rate and other serious illnesses are the best predictors of unsuccessful treatment, but models based on these variables provide modest predictive value.

Cited by 8 publications

References 13 publications

PEFR monitoring can better predict asthma exacerbation as compared to monitoring by symptoms: prospective cohort study

PEFR monitoring can better predict asthma exacerbation as compared to monitoring by symptoms: prospective cohort study

Acute Asthma, Prognosis, and Treatment

Chinese expert consensus-based guideline on assessment and management of asthma exacerbation

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