@article{6c68518f4e794226a75af5b82ae9ceec,
title = "Distinguishing characteristics of difficult-to-control asthma in inner-city children and adolescents",
abstract = "Background Treatment levels required to control asthma vary greatly across a population with asthma. The factors that contribute to variability in treatment requirements of inner-city children have not been fully elucidated. Objective We sought to identify the clinical characteristics that distinguish difficult-to-control asthma from easy-to-control asthma. Methods Asthmatic children aged 6 to 17 years underwent baseline assessment and bimonthly guideline-based management visits over 1 year. Difficult-to-control and easy-to-control asthma were defined as daily therapy with 500 μg of fluticasone or greater with or without a long-acting β-agonist versus 100 μg or less assigned on at least 4 visits. Forty-four baseline variables were used to compare the 2 groups by using univariate analyses and to identify the most relevant features of difficult-to-control asthma by using a variable selection algorithm. Nonlinear seasonal variation in longitudinal measures (symptoms, pulmonary physiology, and exacerbations) was examined by using generalized additive mixed-effects models. Results Among 619 recruited participants, 40.9% had difficult-to-control asthma, 37.5% had easy-to-control asthma, and 21.6% fell into neither group. At baseline, FEV1 bronchodilator responsiveness was the most important characteristic distinguishing difficult-to-control asthma from easy-to-control asthma. Markers of rhinitis severity and atopy were among the other major discriminating features. Over time, difficult-to-control asthma was characterized by high exacerbation rates, particularly in spring and fall; greater daytime and nighttime symptoms, especially in fall and winter; and compromised pulmonary physiology despite ongoing high-dose controller therapy. Conclusions Despite good adherence, difficult-to-control asthma showed little improvement in symptoms, exacerbations, or pulmonary physiology over the year. In addition to pulmonary physiology measures, rhinitis severity and atopy were associated with high-dose asthma controller therapy requirement.",
keywords = "Child, IgE, allergen sensitization, asthma, asthma exacerbations, asthma morbidity, asthma phenotype, asthma severity, inner-city asthma, pulmonary function, rhinitis",
author = "Pongracic, {Jacqueline A.} and Krouse, {Rebecca Z.} and Babineau, {Denise C.} and Zoratti, {Edward M.} and Cohen, {Robyn T.} and Wood, {Robert A.} and {Khurana Hershey}, {Gurjit K.} and Kercsmar, {Carolyn M.} and Gruchalla, {Rebecca S.} and Meyer Kattan and Teach, {Stephen J.} and Johnson, {Christine C.} and Bacharier, {Leonard B.} and Gern, {James E.} and Sigelman, {Steven M.} and Gergen, {Peter J.} and Alkis Togias and Visness, {Cynthia M.} and Busse, {William W.} and Liu, {Andrew H.}",
note = "Funding Information: This project has been funded in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases (NIAID), National Institutes of Health (NIH), Department of Health and Human Services (under contract nos. HHSN272200900052C and HHSN272201000052I, and 1UM1AI114271-01). Additional support was provided by the National Center for Research Resources (NCRR), and the National Center for Advancing Translational Sciences (NCATS), NIH (under grant nos. NCRR/NIH UL1TR000451, UL1RR025780, UL1TR000075 Q1 and NCATS/NIH UL1TR000154, UL1TR001082, UL1TR000077-04, UL1TR000040, UL1TR000150, and UL1TR001105). GlaxoSmithKline (GSK) provided Ventolin, Flovent, Advair, and Flonase under a clinical trial agreement with NIH NIAID; GSK did not have a role in the development or approval of the protocol, conduct of the trial, data analysis, manuscript preparation, or the decision to submit the manuscript for publication. Funding Information: Disclosure of potential conflict of interest: J. A. Pongracic has received travel support and a subcontract from the University of Wisconsin; has received writing assistance, medicines, equipment, or administrative support from GlaxoSmithKline; and has received study drugs for other studies from GlaxoSmithKline, Teva, Merck, Boehringer Ingelheim, and Genentech/Novartis. R. Z. Krouse, D. C. Babineau, and C. M. Visness have received grants from the National Institutes of Health (NIH)–National Institute of Allergy and Infectious Diseases (NIAID). E. M. Zoratti, G. K. Khurana Hershey, C. C. Johnson, and S. M. Sigelman have received grants from the NIH. R. A. Wood has received grants from the NIH, DBV, and Aimmune; has consultant arrangements with Sanofi and Stallergenes; is employed by Johns Hopkins University; and has received royalties from UpToDate. C. M. Kercsmar has received a grant from the NIH and was the chair of Data Safety Monitoring Boards on the GlaxoSmithKline funded, US Food and Drug Administration–mandated VESTRI trial evaluating safety of ICS+LABA vs ICS alone in children. R. S. Gruchalla is employed by the Center for Biologics Evaluation and Research and has consultant arrangements with the Massachusetts Medical Society. M. Kattan has received a grant from the NIH-NIAID and is on the advisory board for Novartis Pharma. S. J. Teach has received grants from the NIH-NIAID, Novartis, PCORI, Fight for Children Foundation, EJF Philanthropies, and the NIH–National Heart, Lung, and Blood Institute; has consultant arrangements with Novartis; and has received royalties from UpToDate. L. B. Bacharier has consultant arrangements with Aerocrine, GlaxoSmithKline, Genentech/Novartis, Cephalon, Teva, and Boehringer Ingelheim; has received payment for lectures from Aerocrine, GlaxoSmithKline, Genentech/Novartis, Merck, Teva, Boehringer Ingelheim, and AstraZeneca; has served on the Scientific Advisory Board for Merck; has served on the Data Safety Monitoring Board for DBV Technologies; has received honoraria for CME program development from WebMD/Medscape; and has served on Advisory Boards for Sanofi and Vectura. J. E. Gern has received grants from the NIH and GlaxoSmithKline; has consultant arrangements with GlaxoSmithKline, Genentech, Amgen, Novartis, Janssen, and Regeneron; has received payment for development of educational presentations from Boehringer Ingelheim; and has stock/stock options in 3V Biosciences. W. W. Busse has received a grant from the NIH-NIAID, has received partial study funding and provision of study drug and placebo from Novartis, is a member of the Data Safety Monitoring Boards for Boston Scientific and Circassia, is a member of the Study Oversight Committee for ICON, and has consultant arrangements with Novartis, GlaxoSmithKline, Genentech, Roche, Pfizer, Merck, Boehringer-Ingelheim, Sanofi, AstraZeneca, Teva, Takeda, Aerocrine, and 3M. A. H. Liu has received a grant from the NIH, is a member of the Data Monitoring Committee for an asthma study for GlaxoSmithKline, and has received payment for lectures from Merck. The rest of the authors declare that they have no relevant conflicts of interest. Publisher Copyright: {\textcopyright} 2016 American Academy of Allergy, Asthma & Immunology",
year = "2016",
month = oct,
day = "1",
doi = "10.1016/j.jaci.2016.06.059",
language = "English (US)",
volume = "138",
pages = "1030--1041",
journal = "Journal of Allergy and Clinical Immunology",
issn = "0091-6749",
publisher = "Mosby Inc.",
number = "4",
}