Overall asthma control: the relationship between current control and future risk

Eric D. Bateman; Helen K. Reddel; Goran Eriksson; Stefan Peterson; Ollie Östlund; Malcolm R. Sears; Christine Jenkins; Marc Humbert; Roland Buhl; Tim W. Harrison; Santiago Quirce; Paul M. O'Byrne

doi:10.1016/j.jaci.2009.11.033

Overall asthma control: the relationship between current control and future risk

Eric D. Bateman, Helen K. Reddel, Goran Eriksson, Stefan Peterson, Ollie Östlund, Malcolm R. Sears, Christine Jenkins, Marc Humbert, Roland Buhl, Tim W. Harrison, Santiago Quirce, Paul M. O'Byrne

Research output: Contribution to journal › Article › peer-review

245 Citations (Scopus)

Abstract

Background: Asthma guidelines emphasize both maintaining current control and reducing future risk, but the relationship between these 2 targets is not well understood.

Objective: This retrospective analysis of 5 budesonide/formoterol maintenance and reliever therapy (Symbicort SMART Turbuhaler∗) studies assessed the relationship between asthma control questionnaire (ACQ-5) and Global Initiative for Asthma-defined clinical asthma control and future risk of instability and exacerbations.

Methods: The percentage of patients with Global Initiative for Asthma–defined controlled asthma over time was assessed for budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies; higher dose inhaled corticosteroid (ICS), same dose ICS/long-acting β2-agonist (LABA), and higher dose ICS/LABA plus short-acting β2-agonist. The relationship between baseline ACQ-5 and exacerbations was investigated. A Markov analysis examined the transitional probability of change in control status throughout the studies.

Results: The percentage of patients achieving asthma control increased with time, irrespective of treatment; the percentage Controlled/Partly Controlled at study end was at least similar to budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies: higher dose ICS (56% vs 45%), same dose ICS/LABA (56% vs 53%), and higher dose ICS/LABA (54% vs 54%). Baseline ACQ-5 score correlated positively with exacerbation rates. A Controlled or Partly Controlled week predicted at least Partly Controlled asthma the following week (≥80% probability). The better the control, the lower the risk of an Uncontrolled week. The probability of an exacerbation was related to current state and was lower with budesonide/formoterol maintenance and reliever therapy.

Conclusions: Current control predicts future risk of instability and exacerbations. Budesonide/formoterol maintenance and reliever therapy reduces exacerbations versus comparators and achieves at least similar control.

Original language	English
Pages (from-to)	600-608.e6
Number of pages	15
Journal	Journal of Allergy and Clinical Immunology
Volume	125
Issue number	3
DOIs	https://doi.org/10.1016/j.jaci.2009.11.033
Publication status	Published - 2010
Externally published	Yes

Keywords

Asthma control
ACQ
exacerbations
GINA

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10.1016/j.jaci.2009.11.033

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title = "Overall asthma control: the relationship between current control and future risk",

abstract = "Background: Asthma guidelines emphasize both maintaining current control and reducing future risk, but the relationship between these 2 targets is not well understood. Objective: This retrospective analysis of 5 budesonide/formoterol maintenance and reliever therapy (Symbicort SMART Turbuhaler∗) studies assessed the relationship between asthma control questionnaire (ACQ-5) and Global Initiative for Asthma-defined clinical asthma control and future risk of instability and exacerbations. Methods: The percentage of patients with Global Initiative for Asthma–defined controlled asthma over time was assessed for budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies; higher dose inhaled corticosteroid (ICS), same dose ICS/long-acting β2-agonist (LABA), and higher dose ICS/LABA plus short-acting β2-agonist. The relationship between baseline ACQ-5 and exacerbations was investigated. A Markov analysis examined the transitional probability of change in control status throughout the studies. Results: The percentage of patients achieving asthma control increased with time, irrespective of treatment; the percentage Controlled/Partly Controlled at study end was at least similar to budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies: higher dose ICS (56\% vs 45\%), same dose ICS/LABA (56\% vs 53\%), and higher dose ICS/LABA (54\% vs 54\%). Baseline ACQ-5 score correlated positively with exacerbation rates. A Controlled or Partly Controlled week predicted at least Partly Controlled asthma the following week (≥80\% probability). The better the control, the lower the risk of an Uncontrolled week. The probability of an exacerbation was related to current state and was lower with budesonide/formoterol maintenance and reliever therapy. Conclusions: Current control predicts future risk of instability and exacerbations. Budesonide/formoterol maintenance and reliever therapy reduces exacerbations versus comparators and achieves at least similar control.",

keywords = "Asthma control, ACQ, exacerbations, GINA",

author = "Bateman, \{Eric D.\} and Reddel, \{Helen K.\} and Goran Eriksson and Stefan Peterson and Ollie {\"O}stlund and Sears, \{Malcolm R.\} and Christine Jenkins and Marc Humbert and Roland Buhl and Harrison, \{Tim W.\} and Santiago Quirce and O'Byrne, \{Paul M.\}",

year = "2010",

doi = "10.1016/j.jaci.2009.11.033",

language = "English",

volume = "125",

pages = "600--608.e6",

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issn = "0091-6749",

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}

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T1 - Overall asthma control

T2 - the relationship between current control and future risk

AU - Bateman, Eric D.

AU - Reddel, Helen K.

AU - Eriksson, Goran

AU - Peterson, Stefan

AU - Östlund, Ollie

AU - Sears, Malcolm R.

AU - Jenkins, Christine

AU - Humbert, Marc

AU - Buhl, Roland

AU - Harrison, Tim W.

AU - Quirce, Santiago

AU - O'Byrne, Paul M.

PY - 2010

Y1 - 2010

N2 - Background: Asthma guidelines emphasize both maintaining current control and reducing future risk, but the relationship between these 2 targets is not well understood. Objective: This retrospective analysis of 5 budesonide/formoterol maintenance and reliever therapy (Symbicort SMART Turbuhaler∗) studies assessed the relationship between asthma control questionnaire (ACQ-5) and Global Initiative for Asthma-defined clinical asthma control and future risk of instability and exacerbations. Methods: The percentage of patients with Global Initiative for Asthma–defined controlled asthma over time was assessed for budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies; higher dose inhaled corticosteroid (ICS), same dose ICS/long-acting β2-agonist (LABA), and higher dose ICS/LABA plus short-acting β2-agonist. The relationship between baseline ACQ-5 and exacerbations was investigated. A Markov analysis examined the transitional probability of change in control status throughout the studies. Results: The percentage of patients achieving asthma control increased with time, irrespective of treatment; the percentage Controlled/Partly Controlled at study end was at least similar to budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies: higher dose ICS (56% vs 45%), same dose ICS/LABA (56% vs 53%), and higher dose ICS/LABA (54% vs 54%). Baseline ACQ-5 score correlated positively with exacerbation rates. A Controlled or Partly Controlled week predicted at least Partly Controlled asthma the following week (≥80% probability). The better the control, the lower the risk of an Uncontrolled week. The probability of an exacerbation was related to current state and was lower with budesonide/formoterol maintenance and reliever therapy. Conclusions: Current control predicts future risk of instability and exacerbations. Budesonide/formoterol maintenance and reliever therapy reduces exacerbations versus comparators and achieves at least similar control.

AB - Background: Asthma guidelines emphasize both maintaining current control and reducing future risk, but the relationship between these 2 targets is not well understood. Objective: This retrospective analysis of 5 budesonide/formoterol maintenance and reliever therapy (Symbicort SMART Turbuhaler∗) studies assessed the relationship between asthma control questionnaire (ACQ-5) and Global Initiative for Asthma-defined clinical asthma control and future risk of instability and exacerbations. Methods: The percentage of patients with Global Initiative for Asthma–defined controlled asthma over time was assessed for budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies; higher dose inhaled corticosteroid (ICS), same dose ICS/long-acting β2-agonist (LABA), and higher dose ICS/LABA plus short-acting β2-agonist. The relationship between baseline ACQ-5 and exacerbations was investigated. A Markov analysis examined the transitional probability of change in control status throughout the studies. Results: The percentage of patients achieving asthma control increased with time, irrespective of treatment; the percentage Controlled/Partly Controlled at study end was at least similar to budesonide/formoterol maintenance and reliever therapy versus the 3 maintenance therapies: higher dose ICS (56% vs 45%), same dose ICS/LABA (56% vs 53%), and higher dose ICS/LABA (54% vs 54%). Baseline ACQ-5 score correlated positively with exacerbation rates. A Controlled or Partly Controlled week predicted at least Partly Controlled asthma the following week (≥80% probability). The better the control, the lower the risk of an Uncontrolled week. The probability of an exacerbation was related to current state and was lower with budesonide/formoterol maintenance and reliever therapy. Conclusions: Current control predicts future risk of instability and exacerbations. Budesonide/formoterol maintenance and reliever therapy reduces exacerbations versus comparators and achieves at least similar control.

KW - Asthma control

KW - ACQ

KW - exacerbations

KW - GINA

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ER -

Overall asthma control: the relationship between current control and future risk

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Keywords

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