Abstract
Background
Reducing near-fatal asthma exacerbations is a critical problem in asthma management.
Objectives
To determine patterns of factors preceding asthma exacerbations in a real-world setting.
Methods
In a nationwide prospective study of 190 patients who had experienced near-fatal asthma exacerbation, cluster analysis was performed using asthma symptoms over the two-week period before admission.
Results
Three distinct clusters of symptoms were defined employing the self-reporting of a visual analogue scale. Cluster A (42.1%): rapid worsening within 7.4 hours from moderate attack to admission, young to middle-aged patients with low BMI and tendency to depression who had stopped anti-asthma medications, smoked, were hypersensitive to environmental triggers and furred pets. Cluster B (40.0%): fairly-rapid worsening within 48 hours, mostly middle-aged and older, relatively good ICS or ICS/LABA compliance, and low perception of dyspnea. Cluster C (17.9%): slow worsening over 10 days before admission, high perception of dyspnea, smokers, and chronic daily mild-moderate symptoms. There were no differences in overuse of short-acting beta-agonists, baseline asthma severity, or outcomes after admission for patients in these three clusters.
Conclusion
To reduce severe or life-threatening asthma exacerbation, personalized asthma management plans should be considered for each cluster. Improvement of ICS and ICS/LABA compliance and cessation of smoking are important in cluster A. To compensate for low perception of dyspnea, asthma monitoring of peak expiratory flow rate and/or exhaled nitric oxide would be useful for patients in cluster B. Avoidance of environmental triggers, increased standard therapy or new anti-type 2 response-targeted therapies should be considered for cluster C.
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from #ORL-AlexandrosSfakianakis via ola Kala on Inoreader http://ift.tt/2ANnlQh
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