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Clinical factors estimated risk for uncontrolled asthma, severe exacerbations

Clinical factors were used to estimate risk for uncontrolled asthma and severe exacerbations, and to develop a risk score for future exacerbations, according to recent study results.

Researchers conducted a retrospective analysis of data from three studies comparing budesonide/formoterol maintenance and reliever therapy with fixed-dose inhaled corticosteroid/long-acting beta2-agonist therapy. Dominant predictors for uncontrolled asthma at 3 months and severe asthma exacerbations within 12 months of commencing treatment were determined by studying baseline patient characteristics.

“The [risk score for exacerbations], right censored at 6 months to include all three studies, was based on the dominant predictors for exacerbations in two thirds of the data set and validated in one third,” the researchers wrote.

The study included 7,446 patients (mean age, 39.5 years; 59% women) with symptoms not controlled on Global Initiative for Asthma (GINA) treatment steps 3 and 4 and with one or more exacerbations. Dominant predictors of uncontrolled asthma and severe exacerbations included GINA step, reliever use, postbronchodilator forced expiratory volume in 1 second (FEV1) and 5-item Asthma Control Questionnaire score (all P<.001). Uncontrolled asthma and smoking status also were dominant predictors, and BMI was a predictor for severe exacerbation.

“An exponential increase in risk was observed with increments in [risk score for exacerbations] based on five selected predictors for exacerbations,” the researchers wrote.

“We have demonstrated differences in the likelihood of achieving and maintaining satisfactory daily clinical control of asthma and future exacerbation risk in at-risk patients who have not achieved a satisfactory level of daily asthma control with previous treatment,” the researchers concluded. “Furthermore, we have developed and validated an [risk score for exacerbations] that, although requiring prospective evaluation in other cohorts, might prove useful for comparing the efficacy of different treatments in improving asthma exacerbation risk across a range of categories and for identifying patients who require treatment to reduce the risk of exacerbations.”

Disclosure: See the study for a full list of relevant financial disclosures