Can We Predict Fall Asthma Exacerbations? Validation Of The Seasonal Asthma Exacerbation Index

Publication date: Available online 24 February 2017
Source:Journal of Allergy and Clinical Immunology
Author(s): Heather E. Hoch, Agustin Calatroni, Joseph B. West, Andrew H. Liu, Peter J. Gergen, Rebecca S. Gruchalla, Khurana G.K. 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
BackgroundA Seasonal Asthma Exacerbation Predictive Index (saEPI) was previously reported based on two prior NIAID Inner City Asthma Consortium trials.ObjectiveWe sought to validate the saEPI in a separate trial designed to prevent fall exacerbations with omalizumab therapy.MethodsThe saEPI and its components were analyzed to characterize those who had an asthma exacerbation during the PROSE (Preventative Omalizumab or Step-Up Therapy for Fall Exacerbations) study. We characterized those inner-city children with and without asthma exacerbations in the fall periods treated with guidelines based therapy (GBT) in the absence and presence of omalizumab.ResultsA higher saEPI was associated with an exacerbation in both the GBT alone (p<0.001, AUC 0.76) and the GBT + omalizumab group (p<0.01, AUC 0.65). In the GBT group, younger age at recruitment, higher total IgE, higher blood eosinophil percent and number, and higher treatment step were associated with those who had an exacerbation compared to 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.ConclusionsAn 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, 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.

Teaser

The saEPI and its individual components help identify children with asthma at high risk or low risk for a fall asthma exacerbation in the presence of guideline-based therapy with and without omalizumab.


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