Can we predict fall asthma exacerbations? Validation of the seasonal asthma exacerbation index

Heather E. Hoch, Agustin Calatroni, Joseph B. West, Andrew H. Liu, Peter J. Gergen, Rebecca S. Gruchalla, Gurjit K. Khurana Hershey, Carolyn M. Kercsmar, Haejin Kim, Carin I. Lamm, Melanie M. Makhija, Herman E. Mitchell, Stephen J. Teach, Jeremy J. Wildfire, William W. Busse, Stanley J. Szefler

Research output: Contribution to journalArticle

25 Scopus citations

Abstract

Background: A Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on 2 prior National Institute of Allergy and Infectious Diseases Inner City Asthma Consortium trials. Objective: This study sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy. Methods: The saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations (PROSE) study. We characterized those inner-city children with and without asthma exacerbations in the fall period treated with guidelines-based therapy (GBT) in the absence and presence of omalizumab. Results: A higher saEPI was associated with an exacerbation in both the GBT alone (P < .001; area under the curve, 0.76) and the GBT + omalizumab group (P < .01; area under the curve, 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percentage and number, and higher treatment step were associated with those who had an exacerbation compared with those who did not. In the GBT + omalizumab group, younger age at recruitment, increased eosinophil number, recent exacerbation, and higher treatment step were also associated with those who had an exacerbation. The saEPI was associated with a high negative predictive value in both groups. Conclusions: An exacerbation in children treated with GBT with or without omalizumab was associated with a higher saEPI along with higher markers of allergic inflammation, treatment step, and a recent exacerbation. Those that exacerbated on omalizumab had similar features with the exception of some markers of allergic sensitization, indicating a need to develop better markers to predict poor response to omalizumab therapy and alternative treatment strategies for children with these risk factors. The saEPI was able to reliably predict those children unlikely to have an asthma exacerbation in both groups.

Original languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology
DOIs
StateAccepted/In press - May 10 2016

Keywords

  • Asthma exacerbation predictors
  • Fall asthma exacerbation
  • Guidelines-based therapy
  • Omalizumab
  • Seasonal Asthma Exacerbation Predictive Index (saEPI)

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

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    Hoch, H. E., Calatroni, A., West, J. B., Liu, A. H., Gergen, P. J., Gruchalla, R. S., Khurana Hershey, G. K., Kercsmar, C. M., Kim, H., Lamm, C. I., Makhija, M. M., Mitchell, H. E., Teach, S. J., Wildfire, J. J., Busse, W. W., & Szefler, S. J. (Accepted/In press). Can we predict fall asthma exacerbations? Validation of the seasonal asthma exacerbation index. Journal of Allergy and Clinical Immunology. https://doi.org/10.1016/j.jaci.2017.01.026