Title

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

Document Type

Article

Publication Date

10-1-2016

Publication Title

The Journal of allergy and clinical immunology

Abstract

BACKGROUND: 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.

OBJECTIVE: We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma.

METHODS: 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.

RESULTS: 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

CONCLUSIONS: 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.

Medical Subject Headings

Adolescent; Age of Onset; Anti-Asthmatic Agents; Asthma; Baltimore; Child; Female; Humans; Longitudinal Studies; Male; Medical History Taking; Poverty; Prospective Studies; Rhinitis; Severity of Illness Index; Urban Population

PubMed ID

27720017

Volume

138

Issue

4

First Page

1030

Last Page

1041

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