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Prospective predictors of exacerbation status in severe asthma over a 3‐year follow‐up
Author(s) -
Kimura H.,
Konno S.,
Makita H.,
Taniguchi N.,
Shimizu K.,
Suzuki M.,
Kimura H.,
Goudarzi H.,
Nakamaru Y.,
Ono J.,
Ohta S.,
Izuhara K.,
Ito Y. M.,
Wenzel S. E.,
Nishimura M.
Publication year - 2018
Publication title -
clinical and experimental allergy
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.462
H-Index - 154
eISSN - 1365-2222
pISSN - 0954-7894
DOI - 10.1111/cea.13170
Subject(s) - exacerbation , medicine , asthma exacerbations , asthma , confounding , biomarker , prospective cohort study , pediatrics , biochemistry , chemistry
Summary Background A predisposition to exacerbations is being recognized as a distinct phenotype with “previous exacerbations” representing the strongest clinical factor associated with future exacerbation. Thus, to identify additional novel biomarkers associated with asthma exacerbations, “past exacerbation status” must be included as a confounding factor. Objective This study aimed to characterize the clinical and biomarker features associated with asthma exacerbations in severe asthma. Methods We evaluated clinical parameters from 105 severe asthmatics yearly for 3 years, as well as their exacerbation status. We classified the subjects into 3 groups: (i) consistent non‐exacerbators ( CNE , subjects who did not experience any exacerbation over the 3‐year period); (ii) consistent frequent exacerbators ( CFE , subjects with frequent exacerbation, defined as those who had 2 or more exacerbations within 1 year, throughout the 3‐year period); and (iii) intermittent exacerbators ( IE ). We conducted multivariate analysis for comparisons among the groups for multiple factors, including several Th2‐related biomarkers, in addition to the “past exacerbation status.” Results Thirty‐nine subjects were classified as CNE , 15 as CFE , and 51 as IE . Frequent exacerbations in the previous year predicted exacerbations for the following year ( P < .001). Among the several Th2‐related biomarkers, only Fe NO was associated with exacerbation status. When we analysed the data after the second visit, the impact of Fe NO on predicting future exacerbation remained significant, even after considering the exacerbation status during the first year ( P < .05). Conclusions and Clinical Relevance Measurement of Fe NO has a significant potential to predict future asthma exacerbation, which is independent of the “past exacerbation history.”