New NHLBI asthma guidelines help predict exacerbations in high-risk patients

MedWire News: Very poorly controlled asthma, as defined by the latest US clinical guidelines, increases the risk for future exacerbations, research shows.

"These data support the 2007 asthma guidelines’ impairment domain as a rigorous framework in which to classify a patient’s asthma control and identify patients at risk for future asthma exacerbations," write Tmirah Haselkorn (Genentech, San Francisco, CA) and colleagues in the Journal of Allergy and Clinical Immunology.

Guidelines for the diagnosis and management of asthma from the National Heart, Lung, and Blood Institute (NHLBI) were updated in 2007 and place greater emphasis on assessing asthma control rather than asthma severity.

The new guidelines also use a combination of measures, including current impairment and future risk, to evaluate asthma control.

In this analysis of a large US outcomes trial, the researchers sought to determine whether patients with very poorly controlled asthma, as defined by the impairment domain of the current NHLBI guidelines, have a higher risk for future asthma exacerbations compared with patients who have their asthma under control.

During a 2-year follow-up of 82 children included in the study, those with consistently very poorly controlled asthma had a six-fold increase in the risk for hospitalization, emergency department visit, or corticosteroid burst compared with those with improved asthma control (odds ratio [OR]=6.4)

Similarly, of the 725 adults and adolescents in the trial, patients with consistently very poor asthma control were nearly three times more likely to have a corticosteroid burst alone (OR=2.8), or be hospitalized, visit the emergency department, or have a corticosteroid burst (OR=3.2) than those with improved asthma control.

Haselkorn and colleagues conclude that the new NHLBI guideline-directed approach for assessing asthma control and evaluating future risk appears to provide clinicians with a straightforward means by which to assess patient status.

"Such information can assist physicians in proactively addressing individual disease management needs and can ultimately help improve asthma-related health outcomes," they write.

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