The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 213-221.e1 , August 2009

Asthma morbidity among inner-city adolescents receiving guidelines-based therapy: Role of predictors in the setting of high adherence

  • Rebecca S. Gruchalla, MD, PhD

      Affiliations

    • University of Texas Southwestern Medical Center, Dallas, Tex
    • Corresponding Author InformationReprint requests: Rebecca S. Gruchalla, MD, PhD, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX 75390-8859.
    • ,
  • Hugh A. Sampson, MD

      Affiliations

    • Mount Sinai School of Medicine, New York, NY
    • ,
  • Elizabeth Matsui, MD

      Affiliations

    • Johns Hopkins University School of Medicine, Baltimore, Md
    • ,
  • Gloria David, PhD, MHSc

      Affiliations

    • Rho, Inc, Chapel Hill, NC
    • ,
  • Peter J. Gergen, MD, MPH

      Affiliations

    • Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
    • ,
  • Agustin Calatroni, MA, MS

      Affiliations

    • Rho, Inc, Chapel Hill, NC
    • ,
  • Mark Brown, MD

      Affiliations

    • University of Arizona College of Medicine, Tucson, Ariz
    • ,
  • Andrew H. Liu, MD

      Affiliations

    • National Jewish Health, Denver, Colo
    • University of Colorado Health Science Center, Denver, Colo
    • ,
  • Gordon R. Bloomberg, MD

      Affiliations

    • Washington University, St Louis, Mo
    • ,
  • James F. Chmiel, MD

      Affiliations

    • Case Western Reserve University School of Medicine, Cleveland, Ohio
    • ,
  • Rajesh Kumar, MD

      Affiliations

    • Children's Memorial Hospital, Chicago, Ill
    • ,
  • Carin Lamm, MD

      Affiliations

    • Columbia University College of Physicians and Surgeons, New York, NY
    • ,
  • Ernestine Smartt, RN

      Affiliations

    • Division of Allergy, Immunology, and Transplantation, National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, Md
    • ,
  • Christine A. Sorkness, PharmD

      Affiliations

    • University of Wisconsin School of Medicine and Public Health, Madison, Wis
    • ,
  • Suzanne F. Steinbach, MD

      Affiliations

    • Boston University School of Medicine, Boston, Mass
    • ,
  • Kelly D. Stone, MD, PhD

      Affiliations

    • Children's National Medical Center, Washington, DC
    • ,
  • Stanley J. Szefler, MD

      Affiliations

    • National Jewish Health, Denver, Colo
    • University of Colorado Denver School of Medicine, Denver, Colo
    • ,
  • William W. Busse, MD

      Affiliations

    • University of Wisconsin School of Medicine and Public Health, Madison, Wis

Received 18 November 2008 ,Revised 21 April 2009 ,Accepted 26 May 2009.

References 

  1. Expert Panel Report 3 (EPR-3): Guidelines for the diagnosis and management of asthma—summary. August 28, 2007. Available at: http://www.nhlbi.nih.gov/guidelines/asthma/asthgdln.pdf 2007. Accessed August 28, 2007.
  2. Busse WW, Lemanske RF. Expert Panel Report 3: Moving forward to improve asthma care. J Allergy Clin Immunol. 2007;120:1012–1014
  3. Szefler SJ, Mitchell H, Sorkness CA, Gergen PJ, O'Connor GT, Morgan WJ, et al. Management of asthma based on exhaled nitric oxide in addition to guideline-based treatment for inner-city adolescents and young adults: a randomised controlled trial. Lancet. 2008;372:1065–1072
  4. Silkoff PE, McClean PA, Slutsky AS, Furlott HG, Hoffstein E, Wakita S, et al. Marked flow-dependence of exhaled nitric oxide using a new technique to exclude nasal nitric oxide. Am J Respir Crit Care Med. 1997;155:260–267
  5. Recommendations for standardized procedures for the on-line and off-line measurement of exhaled lower respiratory nitric oxide and nasal nitric oxide in adults and children-1999. This official statement of the American Thoracic Society was adopted by the ATS Board of Directors, July 1999. Am J Respir Crit Care Med. 1999;160:2104–2117
  6. Silkoff PE, Carlson M, Bourke T, Katial R, Ogren E, Szefler SJ. The Aerocrine exhaled nitric oxide monitoring system NIOX is cleared by the US Food and Drug Administration for monitoring therapy in asthma. J Allergy Clin Immunol. 2004;114:1241–1256
  7. Fahy J, Boushey H, Lazarus S, Mauger E, Reuben M, Cherniak R, et al. Safety and reproducibility of sputum induction in asthmatic subjects in a multicenter study. Am J Respir Crit Care Med. 2001;163:1470–1475
  8. Miller MR, Hankinson J, Brusasco V, Burgos F, Casaburi R, Coates A, et al. Standardisation of spirometry. Eur Respir J. 2005;26:319–338
  9. Strunk RC, Szefler SJ, Phillips BR, Zeiger RS, Chinchilli VM, Larsen G, et al. Relationship of exhaled nitric oxide to clinical and inflammatory markers of persistent asthma in children. J Allergy Clin Immunol. 2003;112:883–892
  10. Evans R, Gergen PJ, Mitchell H, Kattan M, Kercsmar C, Crain E, et al. A randomized clinical trial to reduce asthma morbidity among inner-city children: results of the National Cooperative Inner-City Asthma Study. J Pediatr. 1999;135:332–338
  11. Morgan WJ, Crain EF, Gruchalla RS, O'Connor GT, Kattan M, Evans R, et al. Results of a home-based environmental intervention among urban children with asthma. N Engl J Med. 2004;351:1068–1080
  12. Gromping U. Estimators of relative importance in linear regression based on variance decomposition. Am Stat. 2007;61:139–147
  13. R. Development Core Team. R: a language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2007;
  14. Gromping U. Relative importance for linear regression in R: the package relaimpo. J Stat Softw. 2006;17:1–27
  15. Djukanovic R, Wilson SJ, Kraft M, Jarjour NN, Steel M, Chung KF, et al. Effects of treatment with anti-immunoglobulin E antibody omalizumab on airway inflammation in allergic asthma. Am J Respir Crit Care Med. 2004;170:583–593
  16. Miller MK, Lee JH, Miller DP, Wenzel SE. Recent asthma exacerbations: a key predictor of future exacerbations. Respir Med. 2007;101:481–489
  17. Kwong KYC, Morphew T, Scott L, Guterman J, Jones CA. Asthma control and future asthma-related morbidity in inner city asthmatic children. Ann Allergy Asthma Immunol. 2008;101:144–152
  18. Sullivan SD, Wenzel SE, Bresnahan BW, Zheng B, Lee JH, Pritchard M, et al. Association of control and risk of severe asthma-related events in severe or difficult-to-treat asthma patients. Allergy. 2007;62:655–660
  19. Connolly CK, Mamun M, Alcock SM, Prescott RJ. The Darlington and Northallerton Prospective Asthma Study: best function predicts mortality during the first 10 years. Respir Med. 1998;92:1274–1280
  20. Gelb AF, Flynn Taylor C, Shinar CM, Gutierrez C, Zamel N. Role of spirometry and exhaled nitric oxide to predict exacerbations in treated asthmatics. Chest. 2006;129:1492–1499
  21. Belessis Y, Dixon S, Thomsen A, Duffy B, Rawlinson W, Henry R, et al. Risk factors for an intensive care unit admission in children with asthma. Pediatr Pulmonol. 2004;37:201–209
  22. Harkins MS, Fiato KL, Iwamoto GK. Exhaled nitric oxide predicts asthma exacerbation. J Asthma. 2004;41:471–476
  23. Gruchalla RS, Pongracic J, Plaut M, Evans R, Visness CM, Walter M, et al. Inner City Asthma Study: Relationships among sensitivity, allergen exposure, and asthma morbidity. J Allergy Clin Immunol. 2005;115:478–485
  24. Rosenstreich D, Eggleston P, Kattan M, Baker D, Slavin R, Gergen P, et al. The role of cockroach allergy and exposure to cockroach allergen in causing morbidity among inner-city children with asthma. N Engl J Med. 1997;336:1356–1363
  25. Sporik R, Platts-Mills TA, Cogswell JJ. Exposure to house dust mite allergen of children admitted to hospital with asthma. Clin Exp Allergy. 1993;23:740–746
  26. Eisner MD, Katz PP, Lactao G, Iribarren C. Impact of depressive symptoms on adult asthma outcomes. Ann Allergy Asthma Immunol. 2005;94:566–574
  27. Adams RJ, Smith BJ, Ruffin RE. Factors associated with hospital admissions and repeat emergency department visits for adults with asthma. Thorax. 2000;55:566–573
  28. Deykin A, Lazarus SC, Fahy JV, Wechsler ME, Boushey HA, Chinchilli VM, et al. Sputum eosinophil counts predict asthma control after discontinuation of inhaled corticosteroids. J Allergy Clin Immunol. 2005;115:720–727
  29. Green RH, Brightling CE, McKenna S, Hargadon B, Parker D, Bradding P, et al. Asthma exacerbations and sputum eosinophil counts: a randomised controlled trial. Lancet. 2002;360:1715–1721
  30. Lex C, Jenkins G, Wilson NM, Zacharasiewicz A, Erin E, Hansel TT, et al. Does sputum eosinophilia predict the response to systemic corticosteroids in children with difficult asthma?. Pediatr Pulmonol. 2007;42:298–303
  31. Lex C, Ferreira F, Zacharasiewicz A, Nicholson AG, Haslam PL, Wilson NM, et al. Airway eosinophilia in children with severe asthma: predictive values of noninvasive tests. Am J Respir Crit Care Med. 2006;174:1286–1291
  32. Zacharasiewicz A, Wilson N, Lex C, Erin EM, Li AM, Hansel T, et al. Clinical use of noninvasive measurements of airway inflammation in steroid reduction in children. Am J Respir Crit Care Med. 2005;171:1077–1082
  33. Pharoah PD, Antoniou AC, Easton DF, Ponder BA. Polygenes, risk prediction, and targeted prevention of breast cancer. N Engl J Med. 2008;358:2796–2803
  34. Covar R, Szefler S, Martin R, Sundstrom D, Silkoff P, Murphy J, et al. Relations between exhaled nitric oxide and measures of disease activity among children with mild-to-moderate asthma. J Pediatr. 2003;142:469–475
  35. Jatakanon A, Lim S, Kharitonov S, Chung K, Barnes P. Correlation between exhaled nitric oxide, sputum eosinophils, and methacholine responsiveness in patients with mild asthma. Thorax. 1998;53:91–95
  36. Berlyne GS, Parameswaran K, Kamada D, Efthimiadis A, Hargreave FE. A comparison of exhaled nitric oxide and induced sputum as markers of airway inflammation. J Allergy Clin Immunol. 2000;106:638–644
  37. Berry MA, Shaw DE, Green RH, Brightling CE, Wardlaw AJ, Pavord ID. The use of exhaled nitric oxide concentration to identify eosinophilic airway inflammation: an observational study in adults with asthma. Clin Exp Allergy. 2005;35:1175–1179
  38. Chan-Yeung M, Obata H, Dittrick M, Chan H, Abboud R. Airway inflammation, exhaled nitric oxide, and severity of asthma in patients with western red cedar asthma. Am J Respir Crit Care Med. 1999;159:1434–1438
  39. Mattes J, Storm van's Gravesande K, Reining U, Alving K, Ihorst G, Henschen M, et al. NO in exhaled air is correlated with markers of eosinophilic airway inflammation in corticosteroid-dependent childhood asthma. Eur Respir J. 1999;13:1391–1395
  40. Payne DN, Adcock IM, Wilson NM, Oates T, Scallan M, Bush A. Relationship between exhaled nitric oxide and mucosal eosinophilic inflammation in children with difficult asthma, after treatment with oral prednisolone. Am J Respir Crit Care Med. 2001;164:1376–1381
  41. Jones SL, Kittelson J, Cowan JO, Flannery EM, Hancox RJ, McLachlan CR, et al. The predictive value of exhaled nitric oxide measurements in assessing changes in asthma control. Am J Respir Crit Care Med. 2001;164:738–743
  42. Pijnenburg MW, Hofhuis W, Hop WC, De Jongste JC. Exhaled nitric oxide predicts asthma relapse in children with clinical asthma remission. Thorax. 2005;60:215–218

 Supported in whole or in part with federal funds from the National Institute of Allergy and Infectious Diseases, National Institutes of Health, under contracts NO1-AI-25496 and NO1-AI-25482 and from the National Center for Research Resources, National Institutes of Health, under grants RR00052, M01 RR00533, M01RR0071, 5UL1RR024992-02, and 5M01RR020359-04.

 Disclosure of potential conflict of interest: R. S. Gruchalla receives consulting fees from GlaxoSmithKline, research support from the National Institute of Allergy and Infectious Diseases/National Institutes of Health, Novartis, and ExxonMobil, and is a board member of the American Board of Allergy and Immunology. H. A. Sampson is a consultant for and 4% shareholder in Allertein Pharmaceuticals, LLC; is on the advisory board for Schering-Plough; receives grants from the Food Allergy Initiative and the National Institute of Allergy and Infectious Diseases/National Institutes of Health; is a consultant and scientific advisor for the Food Allergy Initiative; is 45% owner of Herbal Springs, LLC; and is a board member of the American Academy of Allergy, Asthma, and Immunology. E. Matsui receives research support from the National Institutes of Health. M. Brown is a speaker for GlaxoSmithKline and AstraZeneca and a consultant for Novartis. A. H. Liu is a speaker/consultant for GlaxoSmithKline, Merck, and AstraZeneca and receives research support from GlaxoSmithKline. G. R. Bloomberg receives research support from the National Institute of Allergy and Infectious Diseases/National Institutes of Health. J. F. Chmiel is a consultant for MyCysticFibrosis.com, receives honoraria from the France Foundation, and receives grant support from Cystic Fibrosis Foundation Therapeutics, Inc, and the National Institutes of Health. R. Kumar receives grant support from the National Heart, Lung, and Blood Institute/National Institutes of Health, is a member of the American Thoracic Society, and is vice president of the Illinois Society of Allergy and Immunology. C. A. Sorkness receives consulting fees and speaker honoraria from GlaxoSmithKline and receives research support from Pharmaxis and Schering-Plough. S. F. Steinbach receives research support from the National Institute of Allergy and Infectious Diseases/National Institutes of Health and is on the speakers bureau for Merck and GlaxoSmithKline. K. D. Stone receives research support from the National Institute of Allergy and Infectious Diseases/National Institutes of Health. S. J. Szefler is a consultant for GlaxoSmithKline, Genentech, and Merck and receives research support from the National Heart, Lung, and Blood Institute/National Institutes of Health, the National Institute of Allergy and Infectious Diseases/National Institutes of Health, Ross Pharmaceuticals, and GlaxoSmithKline. W. W. Busse is a consultant for Altair, GlaxoSmithKline, Merck, Wyeth, Pfizer, Centocor, Amgen, UCB, Johnson & Johnson, Novartis, AstraZeneca, Eisai, TEVA, CompleWare, KaloBios, and Boehringer Ingelheim Sandoz and receives research support from the National Heart, Lung, and Blood Institute/National Institutes of Health, the National Institute of Allergy and Infectious Diseases/National Institutes of Health, Novartis, Centocor, GlaxoSmithKline, MedImmune, and Ception. The rest of the authors have declared that they have no conflict of interest.

PII: S0091-6749(09)00860-4

doi: 10.1016/j.jaci.2009.05.036

The Journal of Allergy and Clinical Immunology
Volume 124, Issue 2 , Pages 213-221.e1 , August 2009

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