New clinical predictors required to determine future asthma attacks

Screening tests used to predict asthma activity in patients may have little tracking success when applied to people with persistent disease who are adhering to their health care regimens, UT Southwestern Medical Center physician report.

Previous reports have suggested that certain clinical findings and laboratory tests could help predict future asthma attacks. Those earlier conclusions, however, were based on observations of patients with poorly controlled asthma who had not received care based on current guidelines.

The new study appears in the August issue of the Journal of Allergy and Clinical Immunology.

"It was surprising to find that factors often used to predict future asthma risk in poorly treated populations were of no clinical benefit when applied to a well-treated, highly adherent population of inner-city adolescents and young adults with persistent asthma," said Dr. Rebecca Gruchalla, chief of allergy and immunology at UT Southwestern and the new study's lead author.

Early identification of adolescents and young adults at risk for asthma progression may lead to better treatment opportunities and improved disease outcomes in adulthood.

The study involved 546 adolescents and young adults between the ages of 12 and 20 with persistent asthma, a complex disease of the airways that is characterized by variable and recurring symptoms, airflow obstruction, bronchial hyperresponsiveness and underlying inflammation.

The patients, who were in 10 cities across the U.S., received care based on National Institutes of Health (NIH) guidelines for 46 weeks and adhered to the treatment regime. Despite the large number of disease characteristics examined, none was found to be particularly useful in predicting future disease activity.

In order to evaluate patient characteristics that best predicted future asthma symptoms and exacerbations, researchers looked at traditional measurements of disease activity, such as frequency of asthma symptoms and lung function, as well as various markers of inflammation and allergic hypersensitivity.

"These findings highlight the need for us to identify better clinical predictors of asthma morbidity in patients who are both well-treated and who are compliant with their treatment regimes," said Dr. Gruchalla.

The work was supported by the National Institute of Allergy and Infectious Disease (part of the NIH) through the Inner-City Asthma Consortium (ICAC). ICAC is a $55.8 million, six-year project whose purpose is to investigate treatments and causes of asthma in urban children.

In addition to UT Southwestern, researchers from the Mount Sinai School of Medicine; Johns Hopkins University School of Medicine; Boston University School of Medicine; Rho Inc., Chapel Hill, N.C.; University of Arizona College of Medicine; University of Colorado Health Science Center; National Jewish Health, Denver; Washington University; Case Western Reserve University School of Medicine; Children's Memorial Hospital, Chicago; Columbia University College of Physicians and Surgeons; University of Wisconsin School of Medicine and Public Health; and Children's National Medical Center, Washington, D.C., participated in this study.

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