PREDICTORS OF A FUTURE SEVERE ASTHMA EXACERBATION AFTER A DECADE FOLLOW-UP: RESULTS FROM TENOR II

Abstract

Introduction Studies have shown that a prior asthma exacerbation is the strongest predictor of a future exacerbation. Using long-term observational data, we examined whether this association persists using 10-year follow-up data. Methods TENOR II was a multicenter, observational study with a cross-sectional single follow-up assessment of patients with severe/difficult-to-treat asthma more than 10 years after enrollment in the TENOR I study. Multivariable logistic regression assessed predictors of an ATS severe exacerbation at TENOR II using TENOR II variables, with the exception of a severe exacerbation from TENOR I, defined as 1 or more corticosteroid bursts within the 3 months before enrollment. Results A total of 288 patients were included. Mean age was 58.4 (16.0) years, 66.7% were female. Nearly half (46.9%) were obese and a quarter (25.0%) had ever smoked. Geometric mean of total IgE level was 68.9 IU/mL and mean eosinophil level was 197.6 (144.9) µL. Mean % predicted pre- and post-bronchodilator FEV1 was 72.9% and 78.3%, respectively. 71.2% of patients used combined ICS/LABA medication. Statistically significant predictors of a severe exacerbation were combined ICS/LABA use (odds ratio (OR) 3.5, 95% CI: 1.5, 8.0; p=0.004), a severe exacerbation at TENOR I (OR 2.5, 95% CI: 1.3, 4.8; p=0.007), and % predicted post-bronchodilator FEV1 (OR 1.2, 95% CI: 1.0, 1.4; p=0.046). Conclusions A prior severe exacerbation remains a predictor of a future exacerbation in patients with severe/difficult-to-treat asthma after more than a decade. Combined ICS/LABA use, and low post-bronchodilator lung function also increased the odds of a future exacerbation.