PREDICTIVE FACTORS FOR MODERATE OR SEVERE EXACERBATIONS IN ASTHMA PATIENTS RECEIVING OUTPATIENT CARE

FCAAIA Notes: This study tells us that the best predictor of having a moderate or severe asthma exacerbation is a history of a previous such flare.  Incorrect inhaler technique was also predictive. Of course, correct inhaler technique is a subset of using medications in the prescribed doses. If you do not use them, they will not work.

Inhaler technique is difficult to master; medications are expelled from the canister at 60-80 mph, so it is hard to coordinate the puff and inhalation. If your albuterol inhaler provides rapid and temporary relief, we can assume that at least part of the dose is getting in. Don’t hesitate to ask us to review your technique any time. Inhaler errors are often easily corrected, especially if you use a holding chamber attachment when you use the inhaler.

(Source: http://www.medscape.com/viewarticle/882189?nlid=117067_3821&src=WNL_mdplsfeat_170801_mscpedit_aimm&uac=112079PK&spon=38&impID=1401582&faf=1 August 1, 2017.  For Medscape articles: User name: FCAAIA, Password: Allergies)

Abstract

Background: Asthma exacerbations are important events that affect disease control, but predictive factors for severe or moderate exacerbations are not known. The objective was to study the predictive factors for moderate (ME) and severe (SE) exacerbations in asthma patients receiving outpatient care.

Methods: Patients aged > 12 years with asthma were included in the study and followed-up at 4-monthly intervals over a 12-month period. Clinical (severity, level of control, asthma control test [ACT]), atopic, functional, inflammatory, SE and ME parameters were recorded. Univariate analysis was used to compare data from patients presenting at least 1 SE or ME during the follow-up period vs no exacerbations. Statistically significant (p <0.1) factors were then subjected to multiple analysis by binary logistic regression.

Results: A total of 330 patients completed the study, most of whom were atopic (76%), women (nearly 70%), with moderate and mild persistent asthma (>80%). Twenty-seven patients (8%) had a SE and 183 had a ME (58.5%) during follow-up. In the case of SEs, the only predictive factor identified in the multiple analysis was previous SE (baseline visit OR 4.218 95% CI 1.53–11.58, 4-month follow-up OR 6.88 95% CI 2.018–23.51) and inhalation technique (OR 3.572 95% CI 1.324–9.638). In the case of MEs, the only predictive factor found in the multiple analysis were previous ME (baseline visit OR 2.90 95% CI 1.54–5.48, 4-month follow- up OR 1.702 95% CI 1.146–2.529).

Conclusions: The primary predictive factor for SE or ME is prior SE or ME, respectively. SEs seem to constitute a specific patient “phenotype”, in which the sole predictive factor is prior SEs.

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