Symptoms and exacerbations in asthma: an apparent paradox?
Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an...
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Published in | Therapeutic advances in chronic disease Vol. 10; p. 2040622319884387 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
London, England
SAGE Publications
2019
SAGE PUBLICATIONS, INC SAGE Publishing |
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Abstract | Background:
There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate.
Methods:
Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated.
Results:
Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms.
Conclusions:
In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma.
Trial registration:
ClinicalTrials.gov identifier: NCT00861926 |
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AbstractList | Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. Methods: Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. Results: Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. Conclusions: In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. Trial registration: ClinicalTrials.gov identifier: NCT00861926 There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. ClinicalTrials.gov identifier: NCT00861926. Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. Methods: Adults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. Results: Of the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. Conclusions: In uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. Trial registration: ClinicalTrials.gov identifier: NCT00861926 BACKGROUNDThere is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought to be associated. The aim of this study was to analyse asthma symptoms of cough, wheeze, chest tightness and breathlessness in an uncontrolled asthma cohort. We also examined the effect of maintenance and reliever therapy (MART) on these symptoms and its effect on exacerbation rate. METHODSAdults with uncontrolled asthma electronically recorded their asthma symptom severity scores twice-daily over a period of 48 weeks following randomisation to beclometasone/formoterol twice daily plus pro re nata (prn) salbutamol or MART. Subjects with symptom scores of ⩾2 (ranging from 0 to 3 for each symptom) were considered more symptomatic, whereas those below a score of 2 were considered less severe. The influence treatment on exacerbation frequency and symptom profiles were then correlated. RESULTSOf the 1701 subjects in the analyses, 1403 were symptomatic with ⩾100 symptom episodes for one symptom. The remaining 298 subjects were classified as pauci-symptomatic. There was poor association between the frequency and symptom severity score for each symptom. Surprisingly, wheeze was the least reported symptom. Females were more likely to be polysymptomatic. MART compared with prn salbutamol markedly attenuated severe asthma exacerbations. This effect was most notable in subjects with fewer symptoms. CONCLUSIONSIn uncontrolled asthma, there is a poor correlation between reported symptoms and exacerbation frequency. This post hoc analysis suggests that MART should not be reserved for symptomatic subjects but achieves the greatest benefit in pauci-symptomatic patients with asthma. TRIAL REGISTRATIONClinicalTrials.gov identifier: NCT00861926. |
Author | Morice, Alyn H. Morjaria, Jaymin B. Rigby, Alan S. |
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BackLink | https://www.ncbi.nlm.nih.gov/pubmed/31695864$$D View this record in MEDLINE/PubMed |
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CitedBy_id | crossref_primary_10_1002_14651858_CD013518_pub2 crossref_primary_10_1016_j_rmed_2023_107478 crossref_primary_10_2196_17863 crossref_primary_10_23736_S0026_4806_21_07498_X |
Cites_doi | 10.1111/j.1440-1843.2006.00784.x 10.1016/S2213-2600(13)70012-2 10.1164/rccm.200711-1754OC 10.1183/13993003.01655-2017 10.1016/j.pupt.2017.01.010 10.1164/rccm.201512-2452OC 10.1097/MCP.0b013e328332ca2f 10.1186/1471-2466-6-13 10.1016/j.jaci.2009.11.033 10.1378/chest.130.2.429 10.1183/09031936.00019412 10.1016/S0140-6736(17)33311-1 10.1164/rccm.200903-0392OC 10.1016/S0022-3999(00)00203-8 10.1183/09031936.00217813 10.1183/09031936.00202013 10.1183/13993003.01366-2017 10.1016/j.pupt.2010.10.001 10.1056/NEJMoa1715274 |
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Keywords | maintenance and reliever therapy wheeze beclometasone/formoterol chest tightness asthma asthma symptoms breathlessness cough |
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publication-title: Eur Respir J contributor: fullname: Morice – ident: bibr8-2040622319884387 doi: 10.1111/j.1440-1843.2006.00784.x – ident: bibr14-2040622319884387 doi: 10.1016/S2213-2600(13)70012-2 – ident: bibr11-2040622319884387 doi: 10.1164/rccm.200711-1754OC – ident: bibr13-2040622319884387 doi: 10.1183/13993003.01655-2017 – ident: bibr18-2040622319884387 doi: 10.1016/j.pupt.2017.01.010 – ident: bibr10-2040622319884387 doi: 10.1164/rccm.201512-2452OC – ident: bibr6-2040622319884387 doi: 10.1097/MCP.0b013e328332ca2f – ident: bibr15-2040622319884387 doi: 10.1186/1471-2466-6-13 – ident: bibr19-2040622319884387 doi: 10.1016/j.jaci.2009.11.033 – ident: bibr3-2040622319884387 doi: 10.1378/chest.130.2.429 – ident: bibr5-2040622319884387 doi: 10.1183/09031936.00019412 – ident: bibr2-2040622319884387 doi: 10.1016/S0140-6736(17)33311-1 – ident: bibr9-2040622319884387 doi: 10.1164/rccm.200903-0392OC – ident: bibr7-2040622319884387 doi: 10.1016/S0022-3999(00)00203-8 – ident: bibr16-2040622319884387 doi: 10.1183/09031936.00217813 – ident: bibr4-2040622319884387 doi: 10.1183/09031936.00202013 – ident: bibr12-2040622319884387 doi: 10.1183/13993003.01366-2017 – ident: bibr17-2040622319884387 doi: 10.1016/j.pupt.2010.10.001 – ident: bibr20-2040622319884387 doi: 10.1056/NEJMoa1715274 – ident: bibr1-2040622319884387 |
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Snippet | Background:
There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are... There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly thought... Background:There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are... BACKGROUNDThere is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are commonly... Background: There is a dearth of data on prospectively recorded symptoms in patients with uncontrolled asthma. Asthma symptoms and exacerbation rate are... |
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StartPage | 2040622319884387 |
SubjectTerms | Adults Asthma Clinical trials Disease management Dyspnea Evidence-based medicine Exacerbations of Chronic Respiratory Diseases Inhalers Trends |
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Title | Symptoms and exacerbations in asthma: an apparent paradox? |
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