Prognostic factors of asthma severity: A 9-year international prospective cohort study

Roberto de Marco; Alessandro Marcon; Deborah Jarvis; Simone Accordini; Enrique Almar; Massimiliano Bugiani; Adriana Carolei; Lucia Cazzoletti; Angelo Corsico; David Gislason; Amund Gulsvik; Rain Jõgi; Alessandra Marinoni; Jesús Martínez-Moratalla; Isabelle Pin; Christer Janson

doi:10.1016/j.jaci.2006.03.019

Prognostic factors of asthma severity: A 9-year international prospective cohort study

Roberto de Marco^*, Alessandro Marcon, Deborah Jarvis, Simone Accordini, Enrique Almar, Massimiliano Bugiani, Adriana Carolei, Lucia Cazzoletti, Angelo Corsico, David Gislason, Amund Gulsvik, Rain Jõgi, Alessandra Marinoni, Jesús Martínez-Moratalla, Isabelle Pin, Christer Janson

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV ₁% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.

Original language	English
Pages (from-to)	1249-1256
Number of pages	8
Journal	Journal of Allergy and Clinical Immunology
Volume	117
Issue number	6
DOIs	https://doi.org/10.1016/j.jaci.2006.03.019
Publication status	Published - Jun 2006
Externally published	Yes

Bibliographical note

Funding Information:
The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program.

Keywords

Asthma
ECRHS
European Community Respiratory Health Survey
Global Initiative for Asthma (GINA) guidelines
IgE
asthma remission
body mass index
prognostic factors
prospective cohort study
severity

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10.1016/j.jaci.2006.03.019

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de Marco, R., Marcon, A., Jarvis, D., Accordini, S., Almar, E., Bugiani, M., Carolei, A., Cazzoletti, L., Corsico, A., Gislason, D., Gulsvik, A., Jõgi, R., Marinoni, A., Martínez-Moratalla, J., Pin, I., & Janson, C. (2006). Prognostic factors of asthma severity: A 9-year international prospective cohort study. Journal of Allergy and Clinical Immunology, 117(6), 1249-1256. https://doi.org/10.1016/j.jaci.2006.03.019

@article{5b1eb695d17c4031b46c05a00af53fcf,

title = "Prognostic factors of asthma severity: A 9-year international prospective cohort study",

abstract = "Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.",

keywords = "Asthma, ECRHS, European Community Respiratory Health Survey, Global Initiative for Asthma (GINA) guidelines, IgE, asthma remission, body mass index, prognostic factors, prospective cohort study, severity",

author = "{de Marco}, Roberto and Alessandro Marcon and Deborah Jarvis and Simone Accordini and Enrique Almar and Massimiliano Bugiani and Adriana Carolei and Lucia Cazzoletti and Angelo Corsico and David Gislason and Amund Gulsvik and Rain J{\~o}gi and Alessandra Marinoni and Jes{\'u}s Mart{\'i}nez-Moratalla and Isabelle Pin and Christer Janson",

note = "Funding Information: The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program. ",

year = "2006",

month = jun,

doi = "10.1016/j.jaci.2006.03.019",

language = "English",

volume = "117",

pages = "1249--1256",

journal = "Journal of Allergy and Clinical Immunology",

issn = "0091-6749",

publisher = "Elsevier Inc.",

number = "6",

}

de Marco, R, Marcon, A, Jarvis, D, Accordini, S, Almar, E, Bugiani, M, Carolei, A, Cazzoletti, L, Corsico, A, Gislason, D, Gulsvik, A, Jõgi, R, Marinoni, A, Martínez-Moratalla, J, Pin, I & Janson, C 2006, 'Prognostic factors of asthma severity: A 9-year international prospective cohort study', Journal of Allergy and Clinical Immunology, vol. 117, no. 6, pp. 1249-1256. https://doi.org/10.1016/j.jaci.2006.03.019

TY - JOUR

T1 - Prognostic factors of asthma severity

T2 - A 9-year international prospective cohort study

AU - de Marco, Roberto

AU - Marcon, Alessandro

AU - Jarvis, Deborah

AU - Accordini, Simone

AU - Almar, Enrique

AU - Bugiani, Massimiliano

AU - Carolei, Adriana

AU - Cazzoletti, Lucia

AU - Corsico, Angelo

AU - Gislason, David

AU - Gulsvik, Amund

AU - Jõgi, Rain

AU - Marinoni, Alessandra

AU - Martínez-Moratalla, Jesús

AU - Pin, Isabelle

AU - Janson, Christer

N1 - Funding Information: The coordination of the European Community Respiratory Health Survey II was supported by the European Commission as part of their Quality of Life program.

PY - 2006/6

Y1 - 2006/6

N2 - Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.

AB - Background: The natural history of asthma severity is poorly known. Objective: To investigate prognostic factors of asthma severity. Methods: All current patients with asthma identified in 1991 to 1993 in the European Community Respiratory Health Survey were followed up, and their severity was assessed in 2002 by using the Global Initiative for Asthma categorization (n = 856). Asthma severity (remittent, intermittent, mild, moderate, severe) was related to potential determinants evaluated at baseline and during the follow-up by a multinomial logistic model, using the intermittent group as the reference category for relative risk ratios (RRRs). Results: Asthma severity measured at baseline was a determinant of a patient's severity at the end of the follow-up. At baseline, severe persistent had a poorer FEV 1% predicted, a poorer symptom control, higher IgE levels (RRR, 2.06; 95% CI, 1.38-3.06), and a higher prevalence of chronic cough/mucus hypersecretion (RRR, 4.90; 95% CI, 2.18-11.02) than patients with intermittent asthma. Moderate persistent showed the same prognostic factors as severe persistent, even if the associations were weaker. Mild persistent had a distribution of prognostic factors that was similar to patients with intermittent asthma, although the former showed a poorer symptom control than the latter. Remission mainly occurred in patients with less severe asthma and was negatively associated with a change in body mass index (RRR, 0.86; 95% CI, 0.75-0.97). Allergic rhinitis, smoking, and respiratory infections in childhood were not associated with asthma severity. Conclusion: Patients with moderate and severe persistent asthma are characterized by early deterioration of lung function. High IgE levels and persistent cough/mucus hypersecretion are strong markers of moderate/severe asthma, which seems to be a different phenotype from mild persistent or intermittent asthma. Clinical implications: Our results suggest that the evolution of asthma severity is to a large extent predictable.

KW - Asthma

KW - ECRHS

KW - European Community Respiratory Health Survey

KW - Global Initiative for Asthma (GINA) guidelines

KW - IgE

KW - asthma remission

KW - body mass index

KW - prognostic factors

KW - prospective cohort study

KW - severity

UR - http://www.scopus.com/inward/record.url?scp=33646918354&partnerID=8YFLogxK

U2 - 10.1016/j.jaci.2006.03.019

DO - 10.1016/j.jaci.2006.03.019

M3 - Article

C2 - 16750983

AN - SCOPUS:33646918354

SN - 0091-6749

VL - 117

SP - 1249

EP - 1256

JO - Journal of Allergy and Clinical Immunology

JF - Journal of Allergy and Clinical Immunology

IS - 6

ER -

Prognostic factors of asthma severity: A 9-year international prospective cohort study

Abstract

Bibliographical note

Keywords

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