Journal of Allergy and Clinical Immunology
Asthma outcomes: Exacerbations
Section snippets
Definition and methodology for measurement
Almost no 2 studies define “asthma exacerbation” in the same way. The most commonly included exacerbation outcomes were the need for systemic corticosteroids, urgent unscheduled care, specifically ED or urgent care (UC) visits, and hospitalizations for asthma.
The subcommittee proposes the following definition, primarily based on the ATS/ERS statement: “An exacerbation is a worsening of asthma requiring the use of systemic corticosteroids (or for patients on a stable maintenance dose, an
A component-based definition of “asthma exacerbation”
Many definitions of “asthma exacerbation” combine multiple components, such as change in symptoms, lung function, and SABA use. The subcommittee believes that this approach should be pursued with the goal of developing and validating a standard, component-based definition. There has been increasing awareness of heterogeneity of the underlying disease processes in asthma. Recent reports have highlighted the importance of different asthma phenotypes and their natural history.124, 125, 126, 127,
Definition and methodology for measurement
There are differences in the way exacerbations are currently measured in different age groups. In addition to the use of systemic (or increase in inhaled) corticosteroids, other frequently used measures for diagnosing an asthma exacerbation in a pediatric population include documentation of respiratory signs and symptoms, symptom scores, use of SABAs, and response to SABAs. Objective measures, including pulse oximetry, and exhaled Feno also have been used for defining exacerbations in children
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The Asthma Outcomes workshop was funded by contributions from the National Institute of Allergy and Infectious Diseases; the National Heart, Lung, and Blood Institute; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; the Agency for Healthcare Research and Quality; and the Merck Childhood Asthma Network, as well as by a grant from the Robert Wood Johnson Foundation. Contributions from the National Heart, Lung, and Blood Institute; the National Institute of Allergy and Infectious Diseases; the Eunice Kennedy Shriver National Institute of Child Health and Human Development; the National Institute of Environmental Health Sciences; and the US Environmental Protection Agency funded the publication of this article and all other articles in this supplement.
Disclosure of potential conflict of interest: A. Fuhlbrigge is on the Merck Respiratory Advisory Board and is a consultant for the Lovelace Respiratory and Research Institute. D. Peden has received research support from the NIH/NIAID, MedImmune, the US Environmental Protection Agency, and Aquinox Pharmaceuticals. A. J. Apter has received research support from the NHLBI and is on the AAAAI Board of Directors. H. A. Boushey has provided ad-hoc consultation for Kalobics; is on the Pharmaxis advisory committee; is on the ad-hoc advisory committee for Merck and GlaxoSmithKline; has provided consultation for Genentech and Johnson & Johnson; and has received research support from GlaxoSmithKline and Genentech. C. A. Camargo, Jr, is a consultant for Dey, Genentech, Merck, Novartis, and Pfizer; and has received research support from GlaxoSmithKline and Sanofi-Aventis. J. Gern is on the Scientific Advisory Board and has stock options in 3V Biosciences, and has received consulting fees from Centocor, Boehringer Ingelheim, GlaxoSmithKline, Biota, MedImmune, and Theraclone. P. W. Heymann has received research support from the NIH and Novartis. F. D. Martinez has consulted for MedImmune and received lecture honorarium from Abbott. W. G. Teague is a speaker for Merck and Genentech, and has received research support from the NIH/NHLBI and the American Lung Association. C. Blaisdell is on the American Academy of Pediatrics Executive Board and is an abstract reviewer for the Pediatric Academic Society. The rest of the authors declare that they have no relevant conflicts of interest.