Variations in Severity Complicate Asthma Management

A retrospective analysis of two 12-week studies of asthma patients has revealed marked fluctuations in the severity of their disease. This variability can result in an underestimation of severity, which may lead to unnecessary asthma morbidity and, perhaps, mortality. The new study was presented at the annual meeting of the American College of Chest Physicians in San Diego, CA (USA).

Researchers found that patients not taking controller medications can frequently move between severity categories. A patient classified with severe asthma one week may exhibit symptoms or lung function consistent with another severity level the next. Thus, discrete measurements of lung function, albuterol use, or asthma symptoms on any given day may not provide an accurate picture of overall asthma severity and stability.

The study involved patients who had used only beta2-agonists, such as albuterol or salmeterol, and were subsequently randomized to receive placebo and as-needed albuterol. The daily diary data from these patients were reviewed to determine asthma severity based on criteria established by the US National Institutes of Health. The percent of weeks the subjects met criteria for intermittent, mild, moderate, or severe asthma were 9.2%, 13.6%, 71.1%, and 6.1% of weeks, respectively. These data were based on symptom scores, peak expiratory flow, and albuterol use.

"The data demonstrate that asthma not controlled with maintenance medications can be a variable and unpredictable disease, with severity that changes from week to week,” said Paul Dorinsky, M.D., lead author of the study, of GlaxoSmithKline (London, UK). "Physicians should recognize that asthma that may initially be thought to be mild, frequently becomes more severe if these patients are followed over time.”




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