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Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents

Pongracic, Jacqueline A ; Krouse, Rebecca Z ; Babineau, Denise C ; Zoratti, Edward M ; Cohen, Robyn T ; Wood, Robert A ; Khurana Hershey, Gurjit K ; Kercsmar, Carolyn M ; Gruchalla, Rebecca S ; Kattan, Meyer ; Teach, Stephen J ; Johnson, Christine C ; Bacharier, Leonard B ; Gern, James E ; Sigelman, Steven M ; Gergen, Peter J ; Togias, Alkis ; Visness, Cynthia M ; Busse, William W ; Liu, Andrew H

The Journal of Allergy and Clinical Immunology, October 2016, Vol.138(4), pp.1030-1041 [Periódico revisado por pares]

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  • Título:
    Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents
  • Autor: Pongracic, Jacqueline A ; Krouse, Rebecca Z ; Babineau, Denise C ; Zoratti, Edward M ; Cohen, Robyn T ; Wood, Robert A ; Khurana Hershey, Gurjit K ; Kercsmar, Carolyn M ; Gruchalla, Rebecca S ; Kattan, Meyer ; Teach, Stephen J ; Johnson, Christine C ; Bacharier, Leonard B ; Gern, James E ; Sigelman, Steven M ; Gergen, Peter J ; Togias, Alkis ; Visness, Cynthia M ; Busse, William W ; Liu, Andrew H
  • Assuntos: Child ; Asthma ; Inner-City Asthma ; Asthma Phenotype ; Asthma Morbidity ; Asthma Severity ; Asthma Exacerbations ; Pulmonary Function ; Rhinitis ; Allergen Sensitization ; Ige ; Medicine
  • É parte de: The Journal of Allergy and Clinical Immunology, October 2016, Vol.138(4), pp.1030-1041
  • Descrição: Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma. Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models. Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy. Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.
  • Idioma: Inglês

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