Source: Annual Congress 2002 - New aspects of asthma epidemiology
Disease area: Airway diseases

Abstract

Spirometry, use of inhaled corticosteroid (ICS) and disease control have been used to assess asthma severity. In this study, asthma control was defined as no severe exacerbations, no night wakening, no time off work/school and by infrequent use of short-acting [betaagonists. We studied 500 consecutive patients attending an asthma clinic to examine the relevance of the percentage predicted forced expiratory volume in 1 sec (FEV1%) and forced expiratory ratio (FER) in determining asthma severity. The use and dose of ICS, presence of disease control and their assessment of lifestyle restriction by their disease were recorded. We found no relation between measurement of airway obstruction and the other indices of severity. FER was 0.72 and 0.72 (p= .9) and FEV1% 83 and 80 (p= .3) in those with and without disease control respectively. The daily dose of ICS did not differ in relationship to spirometry (p = .5). The dose of ICS was higher in those with poor disease control (beclomethasone equivalent 660μg/day versus 350μg/day) (p <.000001). Overall the use and dose of ICS was the strongest predictor of severity with disease control in 36%, 23%, 14% and 5% of those using ICS 0μg/day, 1-500μg/day, 501-1000μg/day and >1000μg/day respectively (p=.000002). The patients' perception of the restriction of their lifestyle by their asthma also correlated with their use and dose of ICS (p=.005) but not with the degree of airway obstruction (p = .6). We conclude that spirometric measurements of airway obstruction do not correlate with other indices of asthma severity. The use and dose of ICS best predict disease severity with poorest control and more lifestyle restriction in those on the highest doses of ICS.

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Citations should be made in the following way:
R. L. Cowie, M. F. Underwood, S. K. Field (Calgary, Canada). Spirometry is a poor predictor of asthma severity. Eur Respir J 2002; 20: Suppl. 38, 165

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