Source: International Congress 2014 – Management of asthma and other respiratory diseases in primary care
Disease area: Airway diseases

Abstract

Aim: Improved understanding of patient characteristics associated with exacerbations (EXBs) may provide opportunity to minimize future risk. We assessed whether database asthma control can predict future EXBs.Methods: Used a research database to select clinical records of patients aged 18–60yrs with an asthma diagnosis, continuous records over 1 baseline & 1 outcome yr and no other chronic respiratory disease or maintenance oral steroids. Two baseline control measures were evaluated: risk domain asthma control (RDAC) & overall control (OAC). RDAC was absence of: exacerbations, unplanned asthma-related out patient appointments, and antibiotics with evidence of respiratory review (ABX). OAC was: RDAC+average salbutamol £200µg/day. RDAC/OAC components predictive of outcome EXBs in univariable models were entered into a multivariable model and stepwise reduced. EXBs were: oral steroid courses with evidence of respiratory review (OS), asthma-related hospital admission or emergency room [ER] attendance.Results: Of 1558 patients (60% female), 73% and 42% satisfied criteria for RDAC and OAC control, respectively, at baseline.

Baseline Predictors of EXB risk

		Rate Ratio(95%CI)	p-value
Univariable analysis
RDAC (uncontrolled)*		2.78(2.04–3.70)	<0.001
OAC (uncontrolled)*		1.69(1.23–2.33)	<0.001
OS	0	1.00
	1	2.33(1.58–3.42)	<0.001
	£2	2.53(1.54–4.17)
ER attendance	0	1.00
	1	1.58(1.06–2.34)	<0.001
	£2	2.43(1.59–3.71)
ER attendance	0	1.00	0.037
	£1	2.21(1.05–4.66)

Conclusions: Classification as RDAC or OAC at baseline predicted lower EXB rates in the following year. OS, ABX and asthma-related ER attendance independently predicted increased EXB risk regardless of “current control” as indicated by salbutamol use.
*Controlled RR=1.00

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G. Brusselle, R. J. Martin, A. Burden, A. Dima, E. Pizzichini, J. Holbrook, N. G. Papadopoulos, T. Popov, G. Colice, H. K. Reddel, J. von Ziegenweidt, A. Chisholm, D. Price (Ghent, Florianópolis, Belgium; Denver, Baltimore, Washington, United States Of America; Cambridge, Aberdeen, United Kingdom; Amsterdam, Netherlands; Athens, Greece; Sofia, Bulgaria; Sydney, Australia). REG endpoint validation: Do database asthma control measures predict future risk?. Eur Respir J 2014; 44: Suppl. 58, 3022

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