Detection of exacerbations in asthma based on electronic diary data: results from the 1-year prospective BIOAIR study. Issue 7 (6th April 2013)

• Record Type: Journal Article
• Authors: Kupczyk, Maciej; Haque, Shushila; Sterk, Peter J; Niżankowska-Mogilnicka, Ewa; Papi, Alberto; Bel, Elisabeth H; Chanez, Pascal; Dahlén, Barbro; Gaga, Mina; Gjomarkaj, Mark; Howarth, Peter H; Johnston, Sebastian L; Joos, Guy F; Kanniess, Frank; Tzortzaki, Eleni; James, Anna; Middelveld, Roelinde J M; Dahlén, Sven-Erik
• Other Names: Weersink Els author non-byline.; Papadopoulos Nikos author non-byline.; Oikonomidou Erasmia author non-byline.; Zervas Eleftherios author non-byline.; Contoli Marco author non-byline.; Pauwels Romain A. author non-byline.; Brusselle Guy author non-byline.; de Rudder Isabelle author non-byline.; Schelfhout Vanessa author non-byline.; Richter Kai author non-byline.; Gerding Daisy author non-byline.; Magnussen Helgo author non-byline.; Siafakas Nikos M. author non-byline.; Samara Katerina author non-byline.; Plataki Maria author non-byline.; Papadopouli Eva author non-byline.; Szczeklik Andrzej author non-byline.; Ziolkowska-Graca Bozena author non-byline.; Kania Aleksander author non-byline.; Gawlewicz-Mroczka Agnieszka author non-byline.; Duplaga Mariusz author non-byline.; Figiel Ewa author non-byline.; Rabe Klaus F. author non-byline.; Hiemstra Pieter S. author non-byline.; Gauw Stefanie author non-byline.; van Veen Ilonka author non-byline.; Kips Johan C. author non-byline.; Mallia Patrick author non-byline.; Campbell Deborah A author non-byline.; Robinson Douglas S author non-byline.; Fabbri Leo M. author non-byline.; Romagnoli Micaela author non-byline.; Vachier Isabelle author non-byline.; Devautour Catherine author non-byline.; Meziane Lahouari author non-byline.; Maurizio Vignola A. author non-byline.; Pace Elisabetta author non-byline.; Profita Mirella author non-byline.; Holgate Stephen T. author non-byline.; Wilson Susan J. author non-byline.; Hewitt Lorraine author non-byline.; Holoway John author non-byline.; Damm Katarina author non-byline.; Delin Ingrid author non-byline.; Eduards Marianne author non-byline.; Ek Alexandra author non-byline.; Ekström Tommy author non-byline.; Gülich Agneta author non-byline.; Johansson Lovisa E. author non-byline.; Karlsson Östen author non-byline.; Kumlin Maria author non-byline.; Martling Ingrid author non-byline.; Skedinger Maria author non-byline.;
• Is Part Of: Thorax. Volume 68:Issue 7(2013)
• Page Start: 611
• Page End: 618
• Publication Date: 2013-04-06
• Subjects: Asthma -- Asthma Guidelines -- Respiratory Measurement; Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thoraxjnl-2012-201815
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Background: Objective measures are required that may be used as a proxy for exacerbations in asthma. The aim was to determine the sensitivity and specificity of electronic diary data to detect severe exacerbations (SEs) of asthma. A secondary aim was to identify phenotypic variables associated with a higher risk of exacerbation. Methods: In the BIOAIR study, 169 patients with asthma (93 severe (SA); 76 mild to moderate (MA)) recorded lung function, symptoms and medication use in electronic diaries for 1 year. Data were analysed using receiver-operator characteristics curves and related to physician-diagnosed exacerbations. Medical history and baseline clinical data were used to assess risk of exacerbation. Results: Of 122 physician-diagnosed exacerbations, 104 occurred in the SA group (1.1 per patient/year), 18 in the MA group (0.2 per patient/year) and 63 were severe using American Thoracic Society/European Respiratory Society criteria. During exacerbations, peak expiratory flow (PEF) and forced expiratory volume in 1 s significantly decreased, whereas day and night symptoms significantly increased. An algorithm combining a 20% decrease in PEF or a 20% increase in day symptoms on 2 consecutive days was able to detect SEs with 65% sensitivity and 95% specificity. The strongest risk factors for SEs were low Asthma Control Questionnaire score, sputum eosinophils ≥3%, body mass index >25 and low quality of life (St George's Respiratory Questionnaire), with ORs between 3.61 and 2.22 (p<0.05). Conclusions: Regular electronic monitoring of PEF and asthma symptoms provides an acceptable sensitivity and specificity for the detection of SEs and may be suitable for personal internet-based monitoring of asthma control.