Long‐term future risk of severe exacerbations: Distinct 5‐year trajectories of problematic asthma

• DOI: 10.1111/all.13159
• Publication Date: 2017-03-11T08:10:18Z
• Authors: A. C. A. Yii; J. H. Y. Tan; T. S. Lapperre; A. K. W. Chan; S. Y. Low; T. H. Ong; K. L. Tan; S. H. Chotirmall; P. J. Sterk; M. S. Koh
• Keywords: Asthma Exacerbations

Abstract Background Assessing future risk of exacerbations is an important component asthma management. Existing studies have investigated short‐ but not long‐term risk. Problematic patients with unfavorable disease trajectory and persistently frequent severe need to be identified early guide treatment. Aim To identify distinct trajectories exacerbation rates among “problematic asthma” develop a score predict the most trajectory. Methods Severe over five years for 177 presenting specialist clinic were tracked. Distinct using group‐based modeling. Baseline predictors used clinical predicting Results Three found: 58.5% had rare intermittent (“infrequent”), 32.0% at baseline improved subsequently (“nonpersistently frequent”), 9.5% exhibited exacerbations, highest incidence near‐fatal (“persistently frequent”). A composed ≥2 in past year (+2 points), history (+1 point), body mass index ≥25kg/m 2 obstructive sleep apnea gastroesophageal reflux depression point) was predictive “persistently frequent” (area under receiver operating characteristic curve: 0.84, sensitivity 72.2%, specificity 81.1% cutoff ≥3 points). The excellent performance independent validation cohort. Conclusions Patients problematic follow illness period years. We derived validated that accurately identifies who will future.