Predictors of severe exacerbations in patients with moderate and severe asthma

Introduction: The long-term goals of asthma management are to achieve good control of asthma symptoms and to minimize future risk of exacerbations. Aim: To identify predictors of frequent severe exacerbations in patients with moderate to severe asthma. Methods: Adult patients with moderate and severe asthma were included (n=70). They were split into two groups: Group 1 (n=50) ≤ 1 severe exacerbation in the previous year; Group 2 (n=20) > 1 severe exacerbation in the previous year. Demographical, clinical and anthropometrical data were collected. Symptoms and asthma control were assessed (ACQ). Lung function, absolute blood eosinophilic count (AEC), fraction of exhaled nitric oxide (FeNO) and serum levels of IL-5 were measured. Multivariate statistical analysis was used. Results: Predictors of frequent severe exacerbations are persistent allergic rhinitis, nasal polyps, sensitivity to NSAID, ACQ5 and ACQ7 > 1.50, pre FEV1/FVC < 70%, FeNO > 40 ppb, AEC > 550 cells/microL and serum IL-5 levels> 3 pg/ml (table 1). Conclusions: Increase risk for severe exacerbation is associated with poor asthma control, air flow limitation, concomitant upper respiratory tract disease, and markers for severe eosinophilic and/or atopic asthmatic disease. Assessment of these factors could help in improvement of control and reduction of future risk of severe exacerbations.