Asthma and lower airway diseaseIdentifying the components of asthma health status in children with mild to moderate asthma
Section snippets
Methods
Data for this study were taken from the Childhood Asthma Management Program, a double-blind, controlled study designed to evaluate whether the long-term treatment with budesonide or nedocromil produced improvements in lung growth compared with placebo over a period of 5 to 6½ years. Eligible patients were between 5 and 12 years of age with mild or moderate asthma as defined by National Asthma Education and Prevention Program criteria. The protocol for this study was approved by the
Results
Clinical, laboratory, and demographic characteristics of the study population during the screening period before randomization are shown in Table I. Of the 1041 patients enrolled in the trial, 990 had nonmissing values and were used in the analysis at the randomization window. The majority of patients were white and male, and the mean age of this population at baseline was 9.0 ± 2.1. During the randomization window, 40.6% of patients had at least 1 night awakening because of symptoms, and 12.0%
Discussion
Our inclusive analysis has identified a clinically sensible, 5-factor structure explaining between 50% and 60% of the common variance from an inclusive list of variables not previously analyzed together. The factor loading structure remains consistent over the 48-month treatment period and among treatment arms. We believe that this analysis provides further evidence that asthma requires a multicomponent assessment: measurement of 1 or 2 variables alone will not give an adequate picture of the
References (40)
- et al.
Common measures of asthma severity lack association for describing its clinical course
J Allergy Clin Immunol
(1994) - et al.
Lack of correlation of symptoms with specialist-assessed long-term asthma severity
Chest
(1999) - et al.
Validation of a beta-agonist long-term asthma control scale derived from computerized pharmacy data
J Allergy Clin Immunol
(2006) - et al.
Asthma severity: a factor analytic investigation
Am J Med
(1992) - et al.
Relevance of dyspnoea and respiratory function measurements in monitoring of asthma: a factor analysis
Respir Med
(2001) - et al.
Relationships among quality of life, severity, and control measures in asthma: an evaluation using factor analysis
J Allergy Clin Immunol
(2005) - et al.
Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: results of a factor analysis
J Allergy Clin Immunol
(1999) - et al.
Safety and application of induced sputum analysis in childhood asthma
J Allergy Clin Immunol
(2004) - et al.
Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma
J Pediatr
(2003) - et al.
A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up
Chest
(2004)
FEV(1) is associated with risk of asthma attacks in a pediatric population
J Allergy Clin Immunol
Risk factors for hospital admission for asthma from childhood to young adulthood: a longitudinal population study
J Allergy Clin Immunol
Bronchodilation and bronchoconstriction: predictors of future lung function in childhood asthma
J Allergy Clin Immunol
Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial
Lancet
Relationships of bronchial responsiveness assessed by methacholine to serum IgE, lung function, symptoms, and diagnoses in 11-year-old New Zealand children
J Allergy Clin Immunol
Standards for the diagnosis and care of patients with chronic obstructive pulmonary disease (COPD) and asthma
Am Rev Respir Dis
National Asthma Education and Prevention Program Expert Panel Report 2: guidelines for the diagnosis and management of asthma
Agreement among measures of asthma status: a prospective study of low-income children with moderate to severe asthma
Pediatrics
The relationship between airway hyper-responsiveness, markers of inflammation and lung function depends on the duration of the asthmatic disease
Clin Exp Allergy
Validation of the asthma impact survey, a brief asthma-specific quality of life tool
Qual Life Res
Cited by (26)
Indoor ozone and particulate matter modify the association between airborne endotoxin and schoolchildren's lung function
2020, Science of the Total EnvironmentCitation Excerpt :However, there is a dearth of knowledge on the association between indoor endotoxin and lung function, especially in the nearby nations including China, Nepal, India, etc. Lung function, an important indicator of most common lung diseases, including childhood asthma (Anandi et al., 2016; Drummond et al., 2012; Holt et al., 2008), is a critical measurement and early predictor for respiratory health (Sin and Man, 2005). However, to date, few studies evaluated the association between airborne endotoxin and children's lung function, and they only focused on forced expiratory volume in 1 s (FEV1) and FEV1/ forced vital capacity (FVC) of asthmatic children as short-term indicators of asthma exacerbations (Delfino et al., 2015; Matsui et al., 2013; Rabinovitch et al., 2005).
Comparison of Health Care Utilization and Costs for Patients with Asthma by Severity and Health Insurance in Thailand
2016, Value in Health Regional IssuesDiagnostic accuracy of the bronchodilator response in children
2013, Journal of Allergy and Clinical ImmunologyThe clinician's guide on monitoring children with asthma
2013, Paediatric Respiratory ReviewsCitation Excerpt :Although almost every clinical trial in asthma uses some form of monitoring symptoms and reliever medication use, I am not aware of any studies formally evaluating the effect of symptom and bronchodilator use monitoring on the outcome of asthma over time. It has been shown that symptoms and rescue medication use are a distinct domain in the clinical expression of asthma, providing information on disease status independent from exacerbations, lung function, and inflammation.12 Research has also shown that children vary considerably in the degree of airway narrowing they perceive as dyspnoea of sufficient severity to prompt the use of reliever therapy.13
Airway obstruction lability helps distinguish levels of disease activity in asthma
2012, Respiratory MedicineCitation Excerpt :Because the current analysis included outcome variables not included in earlier factor analyses, including several that have not previously been defined, our results differed from those described in earlier studies. Nevertheless, the results of the current PCA share some common features with previous studies, including identifying airway obstruction as a distinct factor12–15 and distinguishing daytime- and nighttime-predominant attributes of asthma.14 The finding that asthma-free days loaded onto nighttime-predominant asthma control is consistent with the close relationship between nocturnal manifestations of asthma and overall control of asthma symptoms.16
Evaluation of the National Heart, Lung, and Blood Institute guidelines impairment domain for classifying asthma control and predicting asthma exacerbations
2012, Annals of Allergy, Asthma and ImmunologyCitation Excerpt :The major features of asthma health status (daytime asthma symptoms or “symptom bother,” nighttime symptoms, activity limitation, nighttime and daytime SABA use, and airway caliber/measures of lung function) evaluated in these studies essentially overlap with the impairment domain components identified by the NHLBI guidelines. However, heterogeneity in these components leads to a level of complexity that accounts for weak correlations between clinical outcomes and impairment or quality-of-life measures.5,25–27 Our analytic approach allowed us to assess and identify the independent contribution of each impairment component on future asthma exacerbation risk.
Supported by National Heart, Lung, and Blood Institute grant NO1-HR-16044-16052 and GlaxoSmithKline.
Disclosure of potential conflict of interest: R. A. Covar has received research support from AstraZeneca, Ross Abbott Laboratories, and Merck. J. Spahn has consulting arrangements with GlaxoSmithKline, has received research support from AstraZeneca and Merck, and is on the speakers' bureau for GlaxoSmithKline and Merck. A. L. Fuhlbrigge is on the speakers' bureau for GlaxoSmithKline and Merck; designed and performed analysis of studies for GlaxoSmithKline, Novartis, and Merck; is on the Data Safety and Monitoring Board for Sepracor; and has received research support from Boehringer Ingelheim, GlaxoSmithKline, and Merck. The rest of the authors have declared that they have no conflict of interest.