Adult Asthma In Korea Research Articles

Effect of biologic therapies on quality of life in severe asthma: Findings from the PRISM study

BackgroundAnti-type 2 (T2) biologic therapies (biologics) improve exacerbation rates, lung function, and asthma-related quality of life (QoL) in patients with severe T2 asthma. However, studies comparing different biologics are lacking. We evaluated the QoL in patients with severe asthma comprehensively and compare the efficacy of different T2-directed biologics using QoL questionnaires. MethodsWe compared the QoL between severe and mild-to-moderate asthma and between severe asthma with and without biologics treatment. Data of mild-to-moderate were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea, and data of severe asthma were collected from the Precision Medicine Intervention in Severe Asthma. We included 183 patients with severe asthma treated with T2 biologics or conventional therapy between April 2020 and May 2021 and assessed QoL of them using the Questionnaire for Adult Korean Asthmatics (QLQAKA), Severe Asthma Questionnaire (SAQ), and EuroQoL-5Dimensions (EQ-5D) at baseline and 6 months. ResultsThe EQ-5D index (0.803) of severe asthma was lower than that of other chronic diseases representing a worse QoL. The scores for all questions of QLQAKA, except “cough,” were lower (less control) in the severe asthma group than in the mild-to-moderate asthma group at baseline and 6 months (P < 0.05). The total scores and subscores of all domains of the QLQAKA, SAQ, and EQ-5D improved significantly 6 months after biologic therapy but not after conventional therapy. The total QLQAKA, SAQ, and EQ-5D scores improved after 6 months in the anti-IL-5 (P < 0.05) and anti-IL-4/IL-13 (P < 0.05) treatment groups with no significant difference between groups (P > 0.05). ConclusionQoL was worse in severe asthma than in mild-to-moderate asthma and other chronic diseases. T2 biologics equally improved QoL in patients with severe asthma.

Comparison of Asthma Phenotypes in Severe Asthma Cohorts (SARP, U-BIOPRED, ProAR and COREA) From 4 Continents.

Asthma is a clinical syndrome with various underlying pathomechanisms and clinical phenotypes. Genetic, ethnic, and geographic factors may influence the differences in clinical presentation, severity, and prognosis. We compared the characteristics of asthma based on the geographical background by analyzing representative cohorts from the United States, Europe, South America, and Asia using the Severe Asthma Research Program (SARP), Unbiased Biomarkers for the Prediction of Respiratory Disease Outcomes (U-BIOPRED), Program for Control of Asthma in Bahia (ProAR), and Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), respectively. The clinical characteristics and medications for the SARP (n = 669), U-BIOPRED (n = 509), ProAR (n = 996), and COREA (n = 3,748) were analyzed. Subgroup analysis was performed for severe asthma. The mean age was highest and lowest in the COREA and SARP, respectively. The asthma onset age was lowest in the ProAR. The mean body mass index was highest and lowest in the SARP and COREA, respectively. Baseline pulmonary function was lowest and highest in the U-BIOPRED and COREA, respectively. The number of patients with acute exacerbation in the previous year was highest in U-BIOPRED. The mean blood eosinophil count was highest in COREA. The total immunoglobulin E was highest in the ProAR. The frequency of atopy was highest in the SARP. The principal component analysis plot revealed differences among all cohorts. The cohorts from 4 different continents exhibited different clinical and physiological characteristics, probably resulting from the interplay between genetic susceptibility and geographical factors.

Serum Zonulin Is a Biomarker for Severe Asthma.

Zonulin is a regulator of epithelial and endothelial barrier function. It regulates intestinal permeability through disrupting tight junctions. Defective epithelial barrier function is a hallmark of airway inflammation in asthma. This study aimed to investigate the role of zonulin in the pathogenesis of severe asthma. We enrolled 56 adult patients with asthma (29 severe asthma and 27 mild-to-moderate asthma) and 33 normal controls. The clinical data, sera, and lung tissues of the patients were provided by the Cohort for Reality and Evolution of adult Asthma in Korea (COREA) and the Biobank of Soonchunhyang University Bucheon Hospital, South Korea. Serum zonulin levels were estimated using an enzyme-linked immunosorbent assay, and zonulin expression in the bronchial tissue was evaluated by immunohistochemical staining. The serum zonulin levels were significantly higher in patients with severe asthma (51.98 ± 19.66 ng/mL) than in those with mild-to-moderate asthma and normal controls (26.35 ± 13.70 vs. 17.26 ± 10.29 ng/mL, P < 0.001). They significantly correlated with percent predicted forced expiratory volume in one second (%FEV1) (r = -0.35, P = 0.009). The zonulin expression in the bronchial epithelium was greater in patients with severe asthma. A serum zonulin cutoff value to distinguish between severe and mild-to-moderate asthmatics was 38.83 ng/mL. Zonulin may play an important role in the pathogenesis of severe asthma, and serum zonulin could be a potential biomarker for severe asthma.

Clinical predictors of treatment response to tiotropium add-on therapy in adult asthmatic patients: From multicenter real-world cohort data in Korea

BackgroundTiotropium, a long-acting muscarinic antagonist, is recommended for add-on therapy to inhaled corticosteroids (ICS)-long-acting beta 2 agonists (LABA) for severe asthma. However, real-world studies on the predictors of response to tiotropium are limited. We investigated the real-world use of tiotropium in asthmatic adult patients in Korea and we identified predictors of positive response to tiotropium add-on. MethodsWe performed a multicenter, retrospective, cohort study using data from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA). We enrolled asthmatic participants who took ICS-LABA with at least 2 consecutive lung function tests at 3-month intervals. We compared tiotropium users and non-users, as well as tiotropium responders and non-responders to predict positive responses to tiotropium, defined as 1) increase in forced expiratory volume in 1 s (FEV1) ≥ 10% or 100 mL; and 2) increase in asthma control test (ACT) score ≥3 after 3 months of treatment. ResultsThe study included 413 tiotropium users and 1756 tiotropium non-users. Tiotropium users had low baseline lung function and high exacerbation rate, suggesting more severe asthma. Clinical predictors for positive response to tiotropium add-on were 1) positive bronchodilator response (BDR) [odds ratio (OR) = 6.8, 95% confidence interval (CI): 1.6–47.4, P = 0.021] for FEV1 responders; 2) doctor-diagnosed asthma-chronic obstructive pulmonary disease overlap (ACO) [OR = 12.6, 95% CI: 1.8–161.5, P = 0.024], and 3) initial ACT score <20 [OR = 24.1, 95% CI: 5.45–158.8, P < 0.001] for ACT responders. FEV1 responders also showed a longer exacerbation-free period than those with no FEV1 increase (P = 0.014), yielding a hazard ratio for the first asthma exacerbation of 0.5 (95% CI: 0.3–0.9, P = 0.016). ConclusionsThe results of this study suggest that tiotropium add-on for uncontrolled asthma with ICS-LABA would be more effective in patients with positive BDR or ACO. Additionally, an increase in FEV1 following tiotropium may predict a lower risk of asthma exacerbation.

Clusters of Severe Eosinophilic Asthma in a Korean Asthma Cohort

Background: Targeted therapies have broadened the available treatment options for patients with severe eosinophilic asthma (SEA). However, differences in the magnitude of treatment responses among patients indicate the presence of various underlying pathophysiological processes and patient subgroups. Objectives: We aimed to describe the characteristics of SEA and identify its patient subgroups. Methods: Clinical data from the Cohort for Reality and Evolution of Adult Asthma in Korea were analyzed. Cluster analysis was performed among those with SEA using 5 variables, namely, prebronchodilator forced expiratory volume in 1 s, body mass index, age at symptom onset, smoking amount, and blood eosinophil counts. Results: Patients with SEA showed prevalent sensitization to aeroallergens, decreased lung function, and poor asthma control status. Cluster analysis revealed 3 distinctive subgroups among patients with SEA. Cluster 1 (n = 177) consisted of patients reporting the lowest blood eosinophils (median, 346.8 cells/μL) and modest severe asthma with preserved lung function during the 12-month treatment period. Cluster 2 (n = 42) predominantly included smoking males with severe persistent airway obstruction and moderate eosinophilia (median, 451.8 cells/μL). Lastly, cluster 3 (n = 95) included patients with the most severe asthma, the highest eosinophil levels (median, 817.5 cells/μL), and good treatment response in terms of improved lung function and control status. Conclusions: Three subgroups were identified in SEA through the cluster analysis. The distinctive features of each cluster may help physicians predict patients who will respond to biologics with greater magnitude of clinical improvement. Further research regarding the underlying pathophysiology and clinical importance of each subgroup is warranted.

Relationship between age and bronchodilator response at diagnosis in adult-onset asthma

BackgroundPossible variation in bronchodilator response (BDR) according to age at the diagnosis of adult-onset asthma is unknown. Our aim was to assess if BDR in FEV1 is related to age at diagnosis of adult-onset asthma and how many subjects fulfill the 400 mL criterion of BDR, the suggested cut-off for asthma-like reversibility in asthma-COPD overlap (ACO).MethodsA total of 1030 patients with adult-onset asthma were included; 245 from SAAS (Seinäjoki Adult Asthma Study, Finland) and 785 from COREA (Cohort for Reality and Evolution of Adult Asthma in Korea) cohorts. BDR in FEV1 at the diagnosis of asthma was assessed. Patients were divided into groups based on age at asthma diagnosis: < 40, 40–59.9, and ≥ 60 years. The cohorts were analyzed separately.ResultsBDR % in FEV1 did not differ between the groups of different age at asthma diagnosis and no correlation between BDR and age was found. Of patients aged ≥40 years, only 18% (SAAS-cohort) and 5% (COREA-cohort) reached the 400 mL BDR in FEV1. After exclusion of possible ACO patients, the results remained similar.ConclusionBy using two large cohorts of steroid-naive patients with asthma, we have shown that BDR at diagnosis of asthma is constant over large age span range, and the limit of 400 mL in BDR in FEV1 is rarely reached.Trial registrationSeinäjoki Adult Asthma Study is registered at ClinicalTrials.gov with identifier number NCT02733016.

Novel Trajectories for Identifying Asthma Phenotypes: A Longitudinal Study in Korean Asthma Cohort, COREA

Unbiased cluster analysis has identified several asthma phenotypes. However, these phenotypes did not consistently predict disease prognosis and reflect temporal variability in airway inflammation. We aimed to identify longitudinal trajectories in terms of pulmonary function parameters and investigated whether the trajectories are associated with prognosis. Data were extracted from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA). Three-year pulmonary function test results were used to apply finite mixture models for group-based trajectory in 486 patients with eligible data set. Two main sets of longitudinal trajectories were identified in terms of FEV1% predicted, and FEV1 variability. In the 4 trajectories determined with FEV1% predicted, the pulmonary function showed a consistent course in 4 stratified levels during 3 years of follow-up, which was associated with unexpected hospital visits and the use of steroid bursts due to exacerbation. The variability in pulmonary function showed 3 different patterns, and we found that higher blood and sputum eosinophil levels were associated with the higher variability in pulmonary function and more exacerbations. Trajectory analysis is a novel method that provides longitudinal asthma phenotypes and aids in prediction of future risk of exacerbation. Further analysis is needed to validate the usefulness of these trajectories in an independent population.

Changing patterns of adult asthma incidence: results from the National Health Insurance Service\u2013National Sample Cohort (NHIS-NSC) database in Korea

This study was conducted to assess the changes in the annual incidence of adult asthma in Korea where the prevalence of asthma had increased steadily in recent decades. A population-based cohort study was conducted using the National Health Insurance Service–National Sample Cohort (NHIS-NSC), which consisted of 746,816 adults aged >20 years between 2004 and 2012. Asthma was defined by two or more physician claims on the basis of a primary diagnostic code for asthma and administration of asthma medications within 1 year. The incidence rates and annual percent change were calculated, and the influence of age and sex on the incidence rates was studied. The annual asthma incidence increased from 3.63 in 2004 to 6.07 per 1,000 person-years in 2008. Since 2008, the asthma incidence did not change significantly. The asthma incidence was higher in women than in men throughout the study periods (p < 0.001) and higher in older than younger age groups (p < 0.001). The asthma incidence did not change in all ages since 2008, except for the 20 s who showed a steady increase. The incidence of asthma in adults reached plateau in Korea, which is consistent with the results from studies in other countries.

High Prevalence of Asthma in Elderly Women: Findings From a Korean National Health Database and Adult Asthma Cohort.

PurposeThe prevalence and burden of asthma is increasing worldwide. In this study, we analyzed 3 different Korean national health survey datasets to determine the general features of adult asthma in Korea and to obtain basic information that would support future strategies for better management of adult asthma.MethodsThe surveys used in this study included the Korea National Health and Nutrition Examination Survey (KNHANES), Korea Community Health Survey (KCHS) and National Health Insurance Service-National Sample Cohort (NHIS-NSC). We investigated annual asthma prevalence, evaluating the rate and risk factors of asthma exacerbation by age and sex, and clinical data of 1,832 patients with asthma who were registered in the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) were analyzed to elucidate risk factors for asthma exacerbation. We also analyzed another asthma cohort and added it as replication data.ResultsIn the KNHANES database, annual asthma prevalence rates varied from 1.2% to 3.1%. In the KCHS database, overall prevalence increased, with significant regional differences (1.6%–2.1%). The NHIS-NSC indicated a gradual increase in annual asthma prevalence from 4.5% to 6.2%. Interestingly, all 3 surveys indicated the highest prevalence of asthma among elderly women. In addition, elderly women with asthma had a significantly higher risk of asthma exacerbation (odds ratio [OR], 1.87; 95% confidence interval [CI], 1.19–2.93; P=0.006). Approximately 11% of patients were classified as having severe asthma. An asthma cohort analysis identified female sex, low baseline pulmonary function, longer treatment duration, high variability in pulmonary function and significant changes in Asthma Control Test scores as risk factors for asthma exacerbation.ConclusionsThe prevalence of asthma in Korea is consistently high among elderly and female populations. These results should lay the foundation for strategies for effective asthma prevention and management; elderly female patients with asthma should receive particular attention.

Healthcare use and prescription patterns associated with adult asthma in Korea: analysis of the NHI claims database

National Health Insurance (NHI) claim records could provide valuable data for epidemiological studies of asthma in Korea. The aim of this study is to estimate the prevalence of adult asthma and to investigate asthma-related healthcare use and prescription patterns in Korea over 5 years. National Health Insurance claim records from January 1, 2006 to December 31, 2010 were analyzed in a retrospective, population-based study. Outcome measures included asthma prevalence, healthcare use, and prescription patterns over time, by type of hospital, and by medical specialty. Additionally, we assessed differences in healthcare use between newly diagnosed and previously diagnosed patients in 2009. Over 5 years, the prevalence of asthma among Korean adults increased from 4944 to 5707 cases per 100,000 population (from 3760 to 4445 in men and from 6108 to 6951 in women). Asthma-related outpatient visits decreased from 4.82 ± 8.02 to 3.44 ± 5.50. Approximately 3% of all patients were hospitalized and 2.4% received asthma-related emergency treatment each year. Pulmonary function tests were performed in 10-11% of patients an average of 1.3 times per year. Newly diagnosed patients experienced fewer asthma-related hospitalizations (1.78% vs 4.35%) and emergency department visits (0.80% vs 2.11%) than the previously diagnosed group. Prescriptions of inhaled corticosteroids-based inhalers were maintained with about 20% of average of all types of hospitals. The prevalence of asthma in Korea has increased over a recent 5-year period, and asthma is still suboptimally controlled. Public health strategies are needed to improve the management of asthma in adults.

Intermittent to Mild Asthma: The Need for Continued Treatment

Asthma is a chronic inflammatory disease of an airway characterized by recurrent attacks of airflow obstruction that is at least partially reversible.1,2 This definition of implies that asthma can be completely reversible. Therefore, most patients with asthma (except those with severe or difficult-to-treat asthma) show the greatest improvement of symptoms in the first few months of therapy. Many newly diagnosed asthma patients irregularly or hardly follow the treatment advice of a physician due to the definition and clinical course of asthma.3,4 According to the Global Initiative for Asthma (GINA) guideline and the Expert Panel Report 3, the goal of therapy in patients with asthma is to achieve asthma control. Asthma classification by severity (previously introduced by the previous GINA documents) is less important than before; however, it is still useful to decide the management at the initial assessment of a patient or when required to characterize a group of patients with asthma who are not in treatment. Recently, the severity of asthma means the intensity of the treatment required to achieve good asthma control.5 This issue of Allergy, Asthma & Immunology Research, Kang and colleagues6 evaluated patients who were newly diagnosed with asthma at a university hospital and were lost to follow-up within 3 years. The authors revealed that 73.9% of patients were lost to follow-up within 3 years and they were younger and had a lower severity of asthma at the time of diagnosis compared with those who had continued management at the hospital. They also showed that 63.3% of non-adherents (who responded to the telephone survey) had not taken any controller mainly due to improved symptoms. Those who did not follow up at the hospital but continued treatment at other hospitals were comparable to those that continued follow-up. Half of the survey respondents answered that the reason to discontinue treatment was due to the long distance to the hospital. Subsequently, the non-treatment group had distinctive characteristics of a young age, best FEV1 and highest PC20 of methacholine, compared to the previous 2 groups. The non-treatment group had intermittent or mild persistent severity of asthma at the time of diagnosis and none of them reported aggravation of asthma despite non-treatment. My colleagues analyzed the characteristics of drop-out patients compared with those who maintained attendance in the COhort for Reality and Evolution of Adult Asthma in Korea (COREA).7 Forty-four percent of the initial participants dropped out from the cohort in the first 18 months. Non-adherents (versus adherents) had a lower mean age, a shorter duration of treatment and lower physician-assessed severity of asthma; in addition, they used fewer controllers and experienced fewer exacerbations. The findings suggest that newly diagnosed patients as well as those previously diagnosed with asthma tend to have lower adherence to their treatment if they have a lower severity of asthma. The updated GINA guideline recommends controller treatment for 1 year even if the patient achieves asthma control and has no symptoms on the lowest dose of controller.1 However, the evidence of this recommendation is the lowest level and based on a panel consensus judgment. Asthma control can deteriorate in weeks to months when an inhaled steroid discontinued.8 There were non-responders to the telephone survey (in contrast to the current guideline or the previous report); however, this retrospective observational study identified no aggravation of asthma control in patients with mild asthma after they stopped the controllers themselves. This provides clinically valuable information in the context of the discrepancy between the doctor's recommendation and the patient's accordance. The choices by patients could be reasonable in light of economic costs and a possible adverse effect caused by unnecessary treatment if they had intermittent or mild persistent asthma. A limitation of this study was that the authors did not evaluate any previous exacerbations or any recurrences of asthma. The diagnosis of asthma was based on the bronchodilator/methacholine challenge testing as they described; however, episodic recurrences/exacerbations of the obstructive symptoms were necessary for the diagnosis of asthma. Frequent exacerbation of asthma is one of the important future risks in asthma control; subsequently, we cannot exclude the possibility that the diagnosis of the subjects included in this study may consist of asthma as well as asthma-like conditions that could show positive results to bronchodilator/Methacholine challenge testing.9-11 For example, a patient with postviral airway hyperresponsiveness could be included in this retrospective cohort and then show no recurrent symptom with no treatment. Further studies focused on mild asthma are necessary to identify patients that require continued treatment despite achieving prolonged asthma control. In terms of the heterogeneity of asthma, developing biomarkers and indices to distinguish the need-to-treat patients could be essential for an optimized and personalized management.

Impact of Atopy on Asthma and Allergic Rhinitis in the Cohort for Reality and Evolution of Adult Asthma in Korea

PurposeAtopy is an important cause of asthma. Few data on the prevalence of atopy or comparisons with clinical characteristics of asthma in Korean patients have been published. We evaluated the effects of atopy on clinical profiles and airway inflammation in Korean asthmatics.MethodsWe retrospectively enrolled 1,492 asthmatics from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) cohort who had undergone skin prick tests for aeroallergens. The patients' clinical characteristics, lung function, PC20, and sputum and blood inflammatory cell counts were compared based on the presence or absence of atopy. Atopy was defined as one or more positive reactions (A/H ratio >1) on a skin prick test.ResultsAmong 11 aeroallergens, house dust mites (Dermatophagoides farinae and Dermatophagoides pteronyssinus) were the most prevalent cause of a positive skin prick test. As compared with non-atopic asthmatics, atopic asthmatics showed early onset of the disease. Atopic patients with asthma had a higher FEV1, FVC, and FEV1/FVC as compared with non-atopic patients with asthma. In addition, asthmatics without atopy had more uncontrolled asthma (P=0.001) and severe rhinitis (P<0.05) as compared with atopic asthmatics. Smoking, as measured in pack years, was higher in the non-atopic asthmatics than in the atopic asthmatics. The erythrocyte sedimentation rate was higher in non-atopic asthmatics than in the atopic asthmatics and patients with non-atopic asthma had a higher sputum neutrophil count than did those with atopic asthma.ConclusionsOur data indicate that atopic asthmatics had an early onset of disease and high IgE levels, while the non-atopic asthmatics had decreased lung function and a high sputum neutrophil count, suggesting that a different approach is needed to treat atopic asthma.

Identification of asthma clusters in two independent Korean adult asthma cohorts

Asthma is a heterogeneous airway disease with various clinical phenotypes. It is crucial to clearly identify clinical phenotypes to achieve better asthma management. We used cluster analysis to classify the clinical groups of 724 asthmatic patients from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), and in 1843 subjects from another independent Korean asthma cohort of Soonchunhyang University Asthma Genome Research Centre (SCH) (Bucheon, Republic of Korea). Hierarchical cluster analysis was performed by Ward's method, followed by κ-means cluster analysis. Cluster analysis of the COREA cohort indicated four asthma subtypes: 1) smoking asthma; 2) severe obstructive asthma; 3) early-onset atopic asthma; and 4) late-onset mild asthma. An independent cluster analysis of the SCH cohort also indicated four clusters that were similar to the COREA clusters. Our results indicate that adult Korean asthma patients can be classified into four distinct clusters.

Airway Hyperresponsiveness Is Negatively Associated with Obesity or Overweight Status in Patients with Asthma

Background: Obesity is a risk factor for asthma in the general population, but the effect of obesity on airway hyperresponsiveness (AFHR) or airway inflammation in asthma is not clear. This study evaluated the relationship between obesity and asthma, assessing aspects of symptoms, AHR, and severity. Methods: In total, 852 patients with asthma diagnosed by asthma specialists based on AHR as confirmed by a methacholine bronchial provocation test, were enrolled from the Cohort for Reality and Evolution of Adult Asthma in Korea (COREA) adult asthma cohort. The intensity of AHR was assessed by the concentration of methacholine needed to cause a 20% decrease in FEV₁ (PC₂₀). Patients were classified into four categories based on body mass index (BMI): underweight (<18.5), normal weight (18.5–24.9), overweight (25.0–29.9), and obese (≥30). Results: BMI was negatively correlated with FEV₁ (l), FVC (l), and FEV₁/FVC (%) in lung function tests. The prevalence of wheezing increased with higher BMI after adjustment for age, sex, smoking, medication history, and PC₂₀ (p < 0.0001). logPC₂₀ was lower in the normal weight group compared with the overweight group (p = 0.003). The risk of moderate or severe AHR (PC₂₀ ≤ 4 mg/ml) decreased with increased BMI after adjustment for age, sex, smoking, and medication history (p = 0.035). Conclusions: Obesity is a risk factor for asthma in the general population, but obesity in asthmatic patients is negatively correlated with the intensity of AHR and is not related to asthma severity. Obesity is positively related with the prevalence of wheezing but negatively related to AHR in asthmatic patients.

Factors associated with severity and exacerbation of asthma: a baseline analysis of the COhort for Reality and Evolution of adult Asthma in Korea (COREA)

Asthma presents with heterogeneous features, and patients show various phenotypes of differing severities. Therefore, it is necessary to define reliable predictable clinical factors that influence severity. To date, few large-scale studies have gathered clinical data on adult asthma patients in Asia. To establish an adult asthma cohort in Korea and to define significant factors associated with asthma severity and exacerbation. Researchers from 11 university hospitals have established an asthma cohort termed the COhort for Reality and Evolution of adult Asthma in Korea (COREA). We classified the severity of asthma into 3 groups: mild, moderate, and severe. In this article, the first analysis of our cohort, we evaluate various clinical factors associated with the severity and exacerbation of asthma using data from 1,260 asthma patients. Physician-evaluated severity of asthma was associated with a history of asthma exacerbation (P < .001), a history of smoking (P < .001), symptom duration (P = .007), and treatment duration (P < .001). It was also significantly correlated with predicted forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) values and FEV1/FVC ratio (all P < .001). Previous exacerbation was associated with smoking (P = .02), predicted FVC and FEV1 values (both P < .001), FEV1/FVC ratio (P = .02), airway hyperresponsiveness (P = .002), and duration of disease (P < .001). Previous exacerbation, duration of disease, and decrease in lung function were important clinical indices associated with asthma severity in the COREA study patients. Our long-term follow-up study is expected to soon yield more accurate and detailed outcomes.

Validity and Reliability of the St. George's Respiratory Questionnaire in Asthmatic Patients

RationaleAsthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics.St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet.MethodsWe used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors.ResultsCronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively.ConclusionsSGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history. RationaleAsthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics.St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. Asthma is a chronic respiratory disease which can affect health related quality of life and finally cause disability. Therefore, adequate and valid assessment of quality of life by questionnaire is one of very important tools in monitoring for level of control in asthmatics. St George's Respiratory Questionnaire (SGRQ), a self-administered questionnaire has been used for evaluation of quality of life in chronic obstructive lung disease and asthma. However, the validity and reliability of SGRQ were not proved in large population of asthmatic patients yet. MethodsWe used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors. We used Korean version of SGRQ permitted by the author previously. We analyzed 688 patients of asthma recruited from ‘Cohort for Reality and Evolution of Adult Asthma in Korea’ (COREA) since the year of 2005. Statistically, we used Cronbach's alpha coefficient for reliability and Pearson's coefficient for the correlation between SGRQ scores and various clinical factors. ResultsCronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. Cronbach's alpha reliability coefficient was 0.92 for total score, 0.49 for the domain of symptoms, 0.88 for activity, and 0.88 for impacts. The correlation coefficients between the total score and symptom duration, diagnosis duration, treatment duration, previous hospital visit due to exacerbation, FVC (predicted %), FEV1 (predicted %), and FVC/FEV1 were 0.179 (p < 0.001), 0.080 (0.140), -0.043 (0.467), -0.163 (<0.001), -0.197 (<0.001), -0.312 (<0.001), and -0.199 (<0.001) respectively. ConclusionsSGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history. SGRQ was a reliable and valid test of quality of life for patients with asthma, and scores were well correlated with duration of symptom, lung function, and previous exacerbation history.

Establishment of Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), a large multi-center long-term cohort study of whole spectrum of asthma

Establishment of Cohort for Reality and Evolution of Adult Asthma in Korea (COREA), a large multi-center long-term cohort study of whole spectrum of asthma

Clinical characteristics of asthmatics susceptible to acute exacerbation by environmental triggers in Cohort for Reality and Evolution of Adult Asthma in Korea (COREA)

Clinical characteristics of asthmatics susceptible to acute exacerbation by environmental triggers in Cohort for Reality and Evolution of Adult Asthma in Korea (COREA)