Asthma and lower airway diseaseConsistently very poorly controlled asthma, as defined by the impairment domain of the Expert Panel Report 3 guidelines, increases risk for future severe asthma exacerbations in The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study
Section snippets
Study population
Full details of the TENOR study have been reported elsewhere.17, 18 This was a 3-year (2001-2004), multicenter, prospective cohort study of 4756 patients aged 6 years or more with severe or difficult-to-treat asthma. Inclusion/exclusion criteria are described in Table E1 (available in this article's Online Repository at www.jacionline.org). Patients were enrolled from diverse geographic sites in the United States to reflect the variety of different settings in which patients with asthma receive
Patient characteristics
Baseline demographics and clinical characteristics for children and adolescents/adults in each cohort (consistently VPC asthma and improved from VPC asthma) are shown in Table I, Table II. Most (62.2%) of the children were consistently classified as having VPC asthma. Children who had VPC asthma were less likely to have private insurance (P = .028) and more likely to be treated by a pulmonologist (P = .003). Among the clinical measures (Table II), children who were consistently classified as
Discussion
This analysis of TENOR study patients with severe or difficult-to-treat asthma demonstrated that having consistently VPC asthma over time, as defined by the impairment domain of the 2007 NHLBI asthma guidelines, predicts future risk for asthma exacerbations. This was evidenced by significantly higher risks for the composite outcome of hospitalizations, ED visits, or corticosteroid bursts in both children and adolescents/adults who had consistently VPC asthma compared with patients who improved
References (52)
The global burden of asthma
Chest
(2006)- et al.
Asthma control, severity, and quality of life: quantifying the effect of uncontrolled disease
J Allergy Clin Immunol
(2007) - et al.
The health economics of asthma and rhinitis. I. Assessing the economic impact
J Allergy Clin Immunol
(2001) - et al.
Recent asthma exacerbations: a key predictor of future exacerbations
Respir Med
(2007) - et al.
Design and baseline characteristics of The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study: a large cohort of patients with severe or difficult-to-treat asthma
Ann Allergy Asthma Immunol
(2004) - et al.
Demographic and clinical characteristics of children and adolescents with severe or difficult-to-treat asthma
J Allergy Clin Immunol
(2007) - et al.
Validation of a standardized version of the Asthma Quality of Life Questionnaire
Chest
(1999) - et al.
Asthma quality of care measures using administrative data: relationships to subsequent exacerbations in multiple databases
J Allergy Clin Immunol
(2008) - et al.
Relationship of validated psychometric tools to subsequent medical utilization for asthma
J Allergy Clin Immunol
(2005) - et al.
Assessment of severity measures for acute asthma outcomes: a first step in developing an asthma clinical prediction rule
Am J Emerg Med
(2008)
Risk factors for emergency department use among children with asthma using primary care in a managed care environment
Ambul Pediatr
Advances in the care of adults with asthma and allergy in 2007
J Allergy Clin Immunol
Characterization of asthma status by parent report and medical record review
J Allergy Clin Immunol
Prevalence of possible undiagnosed asthma and associated morbidity among urban schoolchildren
J Pediatr
Epidemiology of asthma exacerbations
J Allergy Clin Immunol
Severity assessment in asthma: an evolving concept
J Allergy Clin Immunol
Subspecialty differences in asthma characteristics and management
Mayo Clin Proc
Overcoming barriers to nonadherence in asthma treatment
J Allergy Clin Immunol
Predictors of asthma medication nonadherence
Heart Lung
Adherence with montelukast or fluticasone in a long-term clinical trial: results from the mild asthma montelukast versus inhaled corticosteroid trial
J Allergy Clin Immunol
Asthma. Geneva (Switzerland)
The global burden of asthma: executive summary of the GINA Dissemination Committee report
Allergy
Worldwide trends in the prevalence of asthma symptoms: phase III of the International Study of Asthma and Allergies in Childhood (ISAAC)
Thorax
Asthma-specific quality of life and subsequent asthma emergency hospital care
Am J Manag Care
Asthma costs and utilization in a managed care organization
J Allergy Clin Immunol
Cited by (154)
Long-Term Safety of Dupilumab in Patients With Moderate-to-Severe Asthma: TRAVERSE Continuation Study
2024, Journal of Allergy and Clinical Immunology: In PracticeClinical Implications of Longitudinal Blood Eosinophil Counts in Patients With Severe Asthma
2023, Journal of Allergy and Clinical Immunology: In PracticeThe Italian severe/uncontrolled asthma registry (RItA): A 12-month clinical follow-up
2022, Respiratory MedicineEffective Management of Severe Asthma with Biologic Medications in Adult Patients: A Literature Review and International Expert Opinion
2022, Journal of Allergy and Clinical Immunology: In PracticeStrategies for prescription of inhaled corticosteroids in mild-to-moderate asthma
2021, Revue des Maladies RespiratoiresAdult Severe Asthma
2021, Encyclopedia of Respiratory Medicine, Second Edition
Supported by Genentech, Inc, and Novartis Pharmaceuticals Corporation.
Disclosure of potential conflict of interest: J. E. Fish is an employee of Genentech. R. S. Zeiger is a consultant for Aerocrine, AstraZeneca, Genentech, GlaxoSmithKline, Merck, Novartis, and Schering and has received research support from Aerocrine, Sanofi-Aventis, Genentech, Merck & Co, and GlaxoSmithKline. S. J. Szefler is a consultant for GlaxoSmithKline, Genentech, and Merck and has received research support from the National Institutes of Health (NIH)/National Heart, Lung, and Blood Institute (NHLBI) Childhood Asthma Management Program (CAMP), NHLBI Childhood Asthma Research and Education, the NIH/NHLBI Asthma Clinical Research Network, the NIH/National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium, Roos Pharmaceuticals, and GlaxoSmithKline. D. P. Miller is employed by ICON Clinical Research, which received research funding from Genentech. B. E. Chipps has received research support from Genentech, Alcon, and AstraZeneca; has provided expert witness testimony for AstraZeneca regarding Symbicort research; and is a consultant on the speakers' bureau for Sepracor, GlaxoSmithKline, AstraZeneca, Alcon, Genentech, Novartis, Schering-Plough, Aventis, MADA. F. E. R. Simons has received research support from the Canadian Institutes of Health Research. S. T. Weiss is a consultant for Genentech. S. E. Wenzel has received research support from GlaxoSmithKline and is an advisory board member for the Global Initiative for Asthma. L. Borish is a consultant for Genentech, is on the speakers' bureau for Merck, and has received research support from GlaxoSmithKline. E. R. Bleecker is a consultant for AstraZeneca, Boehringer-Ingelheim, Centocor, Genentech, GlaxoSmithKline, Novartis, Pfizer, Wyeth, and Merck and has received research support through Wake Forest University Health Sciences, Aerovance, Amgen, AstraZeneca, Boehringer-Ingelheim, Centocor, Ception, Genentech, GlaxoSmithKline, Novartis, Novartis, Pfizer, and Wyeth. T. Haselkorn has been a paid consultant to Genentech since December 2002.
- ∗
For a complete list of TENOR Study Group members, please contact Genentech, Inc.