Acute severe asthma in emergency department: clinical characteristics, risk factors, and predictors for poor outcome
Tóm tắt
Severe asthma exacerbation can be a frightening experience to the patient and physician. Despite continuous efforts to frame management guidelines and advances in treatment, severe exacerbations still occur. In order to prevent and judicious management of asthma exacerbations, we should predict them first. This study aims to evaluate distinct clinical trajectories and management outcome of patients with severe asthma exacerbations and also evaluate predictors for poor outcome. Patients suffering from acute asthma exacerbation and presented to emergency room (forty patients) were grouped into 2 groups (groups A and B) according to severity of exacerbation. Assessment included full clinical history, laboratory investigations (including eosinophil cell count and serum IgE level), Beck’s anxiety and depression inventory scales, assessment of asthma medication adherence and control level, and peak expiratory flow measurement (at presentation, 1 and 6 h after). Fifty-five percent of patients suffered from severe and life-threatening asthma exacerbations, 63.6% of them were females. The most important predictors for severe exacerbations were SO2 < 90% at baseline (OR = 4.56; 95% CI = 3.45–7.56; P < 0.001), PEFR after 1 h (OR= 3.34; 95%CI = 1.90–4.90; P < 0.001), and uncontrolled asthma (OR= 3.33; 95%CI = 2.50–5.05; P < 0.001). Predictors for hospitalization were old age (OR = 1.11; 95%CI = 1.09–2.11; P < 0.001), uncontrolled asthma (OR = 2.34; 95%CI = 2.01–4.40; P < 0.001), PEFR after 1 h (OR= 4.44; 95%CI= 3.24–7.68; P < 0.001), and SO2 <90% at baseline (OR= 5.67; 95%CI= 3.98–8.50; P < 0.001). Severe asthma exacerbations can be predicted by old age, previous history of mechanical ventilation, obstructive sleep apnea, overuse of SABA, uncontrolled asthma, moderate to severe depression, eosinophilia, SO2 <90%, and low peak expiratory flow rates.
Tài liệu tham khảo
Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention (2021 Update) [(accessed on 10 August 2021)]; Available online: https://ginasthma.org/wp-content/uploads/2021/05/GINA-Main-Report-2021-V2-WMS.pdf
Ramnath VR, Clark S, Camargo CA (2007) Multicenter study of clinical features of sudden-onset versus slower-onset asthma exacerbations requiring hospitalization. Respiratory care. 52(8):1013–1020
Serrano-Pariente J, Rodrigo G, Fiz JA, Crespo A, Plaza V, High Risk Asthma Research Group (2015) Identification and characterization of near-fatal asthma phenotypes by cluster analysis. Allergy. 70(9):1139–1147
Kenyon N, Zeki AA, Albertson TE, Louie S (2015) Definition of critical asthma syndromes. Clinical reviews in allergy & immunology. 48(1):1–6
Kostakou E, Kaniaris E, Filiou E, Vasileiadis I, Katsaounou P, Tzortzaki E et al (2019) Acute severe asthma in adolescent and adult patients: current perspectives on assessment and management. Journal of clinical medicine. 8(9):1283
Gaga M, Zervas E, Samitas K, Bel EH (2012) Severe asthma in adults: an orphan disease? Clinics in chest medicine. 33(3):571–583
Aron J, Akbari O (2017) Regulatory T cells and type 2 innate lymphoid cell-dependent asthma. Allergy. 72(8):1148–1155
Papi A, Brightling C, Pedersen S, Reddel H (2017) Asthma. Lancet 391(2):783–800
Global Initiative for Asthma (GINA) Global Strategy for Asthma Management and Prevention (2019 Update) [(accessed on 6 August 2019)]; Available online: https://ginasthma.org/wp-content/uploads/2019/06/GINA-2019-main-report-June-2019-wms.pdf
Morisky DE, Ang A, Krousel-Wood M, Ward HJ (2008) Predictive validity of a medication adherence measure in an outpatient setting. The journal of clinical hypertension. 10(5):348–354
Thomas M, Kay S, Pike J, Williams A, Rosenzweig J, Hillyer E et al (2009) The Asthma Control Test (ACT) as a predictor of GINA guideline-defined asthma control: analysis of a multinational cross-sectional survey. Primary Care Respiratory Journal 18(1):41–49
Steer RA, Beck AT (1997) Beck Anxiety Inventory. In: Zalaquett CP, Wood RJ (eds) Evaluating stress: a book of resources. Scarecrow Education, pp 23–40
Beck AT, Steer RA, Brown GK (1996) Manual for the beck depression inventory-II. San Antonio, TX: Psychological Corporation. 1(82):10–37
Loymans RJ, Honkoop PJ, Termeer EH, Snoeck-Stroband JB, Assendelft WJ, Schermer TR et al (2016) Identifying patients at risk for severe exacerbations of asthma: development and external validation of a multivariable prediction model. Thorax. 71(9):838–846
Kang HR, Song HJ, Nam JH, Hong SH, Yang SY, Ju S et al (2018) Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea. BMJ open. 8(3):e020825
Yii ACA, Tan JHY, Lapperre TS, Chan AKW, Low SY, Ong TH et al (2017) Long term future risk of severe exacerbations: distinct 5 year trajectories of problematic asthma. Allergy 72:1398–1405
Alvarez GG, Schulzer M, Jung D, Fitzgerald JM (2005) A systematic review of risk factors associated with near-fatal and fatal asthma. Canadian respiratory journal. 12(5):265–270
Gonzalez-Barcala FJ, San-Jose ME, Nieto-Fontarigo JJ, Carreira JM, Calvo-Alvarez U, Cruz MJ, et al (2018) Association between blood eosinophil count with asthma hospital readmissions. Eur J Intern Med 53:34–9
Silverman RA, Hasegawa K, Egan DJ, Stiffler KA, Sullivan AF, Camargo CA Jr (2017) Multicenter study of cigarette smoking among adults with asthma exacerbations in the emergency department, 2011–2012. Respiratory medicine. 125(7):89–91
Merianos AL, Dixon CA, Mahabee-Gittens EM (2017) Secondhand smoke exposure, illness severity, and resource utilization in pediatric emergency department patients with respiratory illnesses. Journal of Asthma. 54(8):798–806
To M, Hitani A, Kono Y, Honda N, Kano I, Haruki K, To Y (2018) Obesity-associated severe asthma in an adult Japanese population. Respiratory investigation. 56(6):440–447
Holguin F, Bleecker ER, Busse WW, Calhoun WJ, Castro M, Erzurum SC et al (2011) Obesity and asthma: an association modified by age of asthma onset. Journal of Allergy and Clinical Immunology. 127(6):1486–1493
Sideleva O, Suratt BT, Black KE, Tharp WG, Pratley RE, Forgione P et al (2012) Obesity and asthma: an inflammatory disease of adipose tissue not the airway. American journal of respiratory and critical care medicine. 186(7):598–605
Kimura H, Konno S, Makita H, Taniguchi N, Shimizu K, Suzuki M et al (2018) Prospective predictors of exacerbation status in severe asthma over a 3-year follow-up. Clinical & Experimental Allergy. 48(9):1137–1146
Belachew SA, Erku DA, Yimenu DK, Gebresillassie BM (2018) Assessment of predictors for acute asthma attack in asthmatic patients visiting an Ethiopian hospital: are the potential factors still a threat? Asthma research and practice. 4(1):1–7
Levy M, Andrews R, Buckingham R, Evans H, Francis C, Houston R, Lowe D, Nasser S, Pation J, Puri N, Stewart K (2014) Why asthma still kills: The national review of asthma deaths (NRAD) confidential enquiry report. Royal College of Physicians.
Khattab A, Madkour A, Ambaram A, Smith C, Muhwa CJ, Mecha JO et al (2022) Over-prescription of short-acting β2-agonists is associated with poor asthma outcomes: results from the African cohort of the SABINA III study. Curr Med Res Opin. 27:1–13
Neffen H, Chahuàn M, Hernández DD, Vallejo-Perez E, Bolivar F, Sánchez MH et al (2020) Key factors associated with uncontrolled asthma–the Asthma Control in Latin America Study. Journal of Asthma. 57(2):113–122
Belachew EA, Tadess S, Alemayehu M, Ayele EM (2022) Level of asthma control and its determinants among adults living with asthma attending selected public hospitals in northwestern, Ethiopia: using an ordinal logistic regression model. Asthma Res Pract. 8(1):5
Chen E, Miller GE (2007) Stress and inflammation in exacerbations of asthma. Brain, behavior, and immunity. 21(8):993–999
Ritz T, Wittchen H-U, Klotsche J, Mühlig S, Riedel O (2016) Asthma trigger reports are associated with low quality of life, exacerbations, and emergency treatments. Annals of the American Thoracic Society. 13(2):204–211
Zeiger RS, Schatz M, Dalal AA, Chen W, Sadikova E, Suruki RY et al (2017) Blood eosinophil count and outcomes in severe uncontrolled asthma: a prospective study. The Journal of Allergy and Clinical Immunology. In Practice. 5(1):144–153
Jackson DJ, Humbert M, Hirsch I, Newbold P, Gil EG (2020) Ability of serum IgE concentration to predict exacerbation risk and benralizumab efficacy for patients with severe eosinophilic asthma. Advances in therapy. 37(2):718–729
Austin D, Pouliquen I, Yancey S, Bleeker E (2016) A blood eosinophil count of greater than 150 cells/uL predicts sputum eosinophilia≥ 3% in patients with severe asthma with other markers of inflammatory lung disease. InB101. PHENOTYPING OF ASTHMA IN THE ERA OF BIOMARKERS AND OMICS. American Thoracic Society, p A4338–A4338
Barbarot N, Nourry E, Massart N, Legay F, Debarre M, Fillatre P et al (2022) Treating acute severe eosinophilic asthma with IL-5 inhibitors in ICU. Case Rep Pulmonol. 21(2022):2180795
Haselkorn T, Szefler SJ, Chipps BE, Bleecker ER, Harkins MS, Paknis B et al (2020) Disease burden and long-term risk of persistent very poorly controlled asthma: TENOR II. The Journal of Allergy and Clinical Immunology. In Practice. 8(7):2243–2253
Kole TM, Berghe EV, Kraft M, Vonk JM, Nawijn MC, Siddiqui S, Sun K, Fabbri LM, Rabe KF, Chung KF, Nicolini G (2022) Predictors and associations of the persistent airflow limitation phenotype in asthma: a post-hoc analysis of the ATLANTIS study. Lancet Respir Med
Bloom CI, Palmer T, Feary J, Quint JK, Cullinan P (2019) Exacerbation patterns in adults with asthma in England. A population-based study. American journal of respiratory and critical care medicine. 199(4):446–453