Format

Send to

Choose Destination
J Allergy Clin Immunol. 2017 Oct;140(4):1130-1137.e5. doi: 10.1016/j.jaci.2017.01.026. Epub 2017 Feb 24.

Can we predict fall asthma exacerbations? Validation of the seasonal asthma exacerbation index.

Author information

1
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo. Electronic address: Heather.hoch@childrenscolorado.org.
2
Rho Federal Systems Division, Chapel Hill, NC.
3
Boston University School of Medicine, Boston, Mass.
4
Children's Hospital Colorado and University of Colorado School of Medicine, Aurora, Colo.
5
National Institute of Allergy and Infectious Diseases, Bethesda, Md.
6
University of Texas Southwestern Medical Center, Dallas, Tex.
7
Cincinnati Children's Hospital, Cincinnati, Ohio.
8
Henry Ford Health System, Detroit, Mich.
9
Columbia University College of Physicians and Surgeons, New York, NY.
10
Ann and Robert H. Lurie Children's Hospital of Chicago, Chicago, Ill.
11
Children's National Health System, Washington, DC.
12
University of Wisconsin School of Medicine and Public Health, Madison, Wis.

Abstract

BACKGROUND:

A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on 2 prior National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium trials.

OBJECTIVE:

This study sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy.

METHODS:

The saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study. We characterized those inner-city children with and without asthma exacerbations in the fall period treated with guidelines-based therapy (GBT) in the absence and presence of omalizumab.

RESULTS:

A higher saEPI was associated with an exacerbation in both the GBT alone (P < .001; area under the curve, 0.76) and the GBT + omalizumab group (P < .01; area under the curve, 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percentage and number, and higher treatment step were associated with those who had an exacerbation compared with those who did not. In the GBT + omalizumab group, younger age at recruitment, increased eosinophil number, recent exacerbation, and higher treatment step were also associated with those who had an exacerbation. The saEPI was associated with a high negative predictive value in both groups.

CONCLUSIONS:

An exacerbation in children treated with GBT with or without omalizumab was associated with a higher saEPI along with higher markers of allergic inflammation, treatment step, and a recent exacerbation. Those that exacerbated on omalizumab had similar features with the exception of some markers of allergic sensitization, indicating a need to develop better markers to predict poor response to omalizumab therapy and alternative treatment strategies for children with these risk factors. The saEPI was able to reliably predict those children unlikely to have an asthma exacerbation in both groups.

KEYWORDS:

Fall asthma exacerbation; Seasonal Asthma Exacerbation Predictive Index (saEPI); asthma exacerbation predictors; guidelines-based therapy; omalizumab

PMID:
28238748
PMCID:
PMC5568982
DOI:
10.1016/j.jaci.2017.01.026
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Elsevier Science Icon for PubMed Central
Loading ...
Support Center