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A New Index of Prognostic Severity for Chronic Asthma

Matthew S. Ellman; Catherine M. Viscoli; Malcolm R. Sears; D. Robin Taylor; William S. Beckett; Ralph I. Horwitz
Author and Funding Information

Affiliations: From the Department of Medicine, Yale University School of Medicine, New Haven, Conn,  From the Division of Respiratory Services, St. Joseph's Hospital, McMaster University, Hamilton, Ont, Canada,  From the Department of Medicine, University of Otago Medical School, Dunedin, New Zealand

Affiliations: From the Department of Medicine, Yale University School of Medicine, New Haven, Conn,  From the Division of Respiratory Services, St. Joseph's Hospital, McMaster University, Hamilton, Ont, Canada,  From the Department of Medicine, University of Otago Medical School, Dunedin, New Zealand

Affiliations: From the Department of Medicine, Yale University School of Medicine, New Haven, Conn,  From the Division of Respiratory Services, St. Joseph's Hospital, McMaster University, Hamilton, Ont, Canada,  From the Department of Medicine, University of Otago Medical School, Dunedin, New Zealand


1997 by the American College of Chest Physicians


Chest. 1997;112(3):582-590. doi:10.1378/chest.112.3.582
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Abstract

Objective: To develop a prognostic clinical index for adults with chronic stable asthma.

Design: Analysis of data from a 48-week randomized, crossover trial of regular vs as-needed inhaled β-agonist therapy.

Patients: Eligible patients included 70 men and women between the ages of 15 and 64 years with asthma for >1 year.

Outcome measure: Asthma deterioration within 20 weeks, defined as either a marked decline in FEV1 (≥1.0 L or ≥30% from baseline) or initiation of systemic corticosteroid therapy for asthma exacerbation.

Results: Three baseline factors independently predicted asthma deterioration: frequent symptoms on waking in the 4 weeks before baseline, past hospitalization for asthma, and age 35 years or older. Based on cross-stratification and consolidation of these prognostic factors, an index was developed that stratified subjects into four risk groups with distinctive deterioration rates of 9%, 21%, 39%, and 67% (p<0.001).

Conclusion: For adults with chronic stable asthma, three simple clinical factors can be combined to stratify effectively for risk of subsequent asthma deterioration.


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