Delivered by Ingenta to: State University New York At Buffalo IP: 191.101.54.203 On: Sun, 12 Jun 2016 07:03:18 Copyright (c) Oceanside Publications, Inc. All rights reserved. For permission to copy go to https://www.oceansidepubl.com/permission.htm What can predict the exacerbation severity in asthma? I. Kivilcim Oguzulgen, M.D.,* Haluk Turktas, M.D.,* Sema Mullaoglu, M.D.,* and Secil Ozkan, M.D.# (Turkey) ABSTRACT There are many well-defined risk factors for fatal asthma exacerbation; however, few data exist about the link between the severity of asthma and severity of exacerbation. The aim of this study was to determine if there is any patient and disease-related factor that predicts the severity of asthma exacerbation. The retrospective data of asthmatic patients followed up in our clinic were analyzed. Asthmatic patients who had at least one exacerbation were included. Patient and disease characteristics, comorbidities, and compliance were evaluated. We analyzed 335 asthma exacerbations of 189 asthmatic patients. Eighteen patients had intermittent asthma, 115 patients had mild persistent asthma, 45 patients had moderate persistent asthma, and 11 patients had severe persistent asthma. Of the 189 asthmatic patients 8.1% of the exacerbations were mild, 52.5% were moderate, and 39.4% were severe. There was a significant correlation between the severity of asthma and severity of exacerbation (r = 0.32; p  0.001). When elderly (60 years old) and younger (60 years old) asthmatic patients were compared, elderly asthmatic patients had severe asthma exacerbation significantly at a higher rate than younger asthmatic patients (severe asthma exacerbation rates are 67.3 and 33.9% in elderly patients and younger asthmatic patients, respectively; p  0.001). A significant correlation was found between the severity of exacerbation and age (r = 0.25; p  0.001). Among the other patient and disease-related factors, asthma severity and older age were the only significant factors that contributed to the severity of exacerbation. These data show that older age as a patient-related factor and worse asthma severity as a disease-related factor could contribute to exacerbation severity in asthmatic patients. (Allergy Asthma Proc 28:344 –347, 2007; doi: 10.2500/aap.2007.28.2949) Key words: Asthma, elderly, exacerbation, older age, retrospective, risk factor, severity A sthma exacerbations are dangerous and some- times life threatening. Other than the exogenous risk factors such as triggers, common reasons for exac- erbations are poor compliance with medications, not understanding that controller medications need to be taken regularly, and ignoring early warning signs of an exacerbation. 1 Confidential enquires into asthma deaths and other clinical studies have established fac- tors associated with the disease, medical management, and patients’ behaviors that contributed to fatal asthma exacerbation. 2– 4 However, few data exist about the fac- tors associated with severity of asthma exacerbation other than fatal exacerbations. In this study, our aim was to determine if there is any patient and disease-related fac- tor predicting the severity of asthma exacerbation. MATERIALS AND METHODS Study Design Retrospective data of asthmatic patients (n = 1680) admitted to our asthma outpatient clinic over a 7-year interval were analyzed for asthma exacerba- tions. Asthma diagnosis was made according to the Global Initiative for Asthma (GINA) recommenda- tions. 5 Asthma degree-of-severity classification was assessed according to the GINA guideline, 5 based on symptoms and the pulmonary function tests ob- tained when the patients were clinically stable and had been free from acute respiratory infections for at least 2 months. Asthmatic patients who had at least one exacerbation during their follow-up in an asthma outpatient clinic were included in the study. Asthma exacerbation was defined as an episode of rapidly progressive increase in asthma-related pulmonary symptoms leading to an unscheduled urgent care visit accompanied by a de- crease in peak expiratory flow (PEF) or forced expira- tory volume in 1 second when compared with the values in a stable clinical state. 5 Exacerbation severity was assessed on a scheme based on PEF according to the GINA (PEF 80% predicted, mild; PEF 60 – 80% predicted, moderate; PEF 60% predicted, severe). 5 Patient characteristics, comorbidities (any other sys- temic disease such as hypertension, diabetes mellitus, renal disorders, thyroid disorders, cardiac disorders, and others), and compliance were recorded. Self-re- ported regular inhaler use and appropriate drug con- sumption rate (according to the prescription doses) were the criteria for compliance. From the Departments of *Pulmonary Medicine and #Public Health, Gazi University School of Medicine, Ankara, Turkey Address correspondence and reprint requests to I. Kivilcim Oguzulgen, M.D., De- partment of Pulmonary Medicine, Gazi University School of Medicine, Turan Gunes Bulvari 92/2, 06550 Cankaya, Ankara, Turkey E-mail address: ipek@gazi.edu.tr Copyright © 2007, OceanSide Publications, Inc., U.S.A. 344 May–June 2007, Vol. 28, No. 3