Does lung function monitoring play important roles in assessing current asthma control?_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

MA Li ¹ , WANG Ji ¹ , KANG Deying ² , ZHANG Hongping ¹ , WANG Lei ¹ ,  WANG Gang ^1,3

1. Pneumology Group, Department of Integrated Traditional Chinese and Western Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
2. Department of Evidence-Based Medicine and Clinical Epidemiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R.China;
3. State Key Laboratory of Biotherapy/Collaborative Innovation Center for Biotherapy, Sichuan University, Chengdu, Sichuan 610041, P.R.China;

Corresponding?author：

WANG Gang, Email: wong-gang@126.com

Keywords：

GINA 2009; GINA 2015; Forced expiratory volume in one second; Current asthma control

DOI：

10.7507/1671-6205.201611038

Video：

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Objective Since 2009, assessment of asthma control in Global Initiative for Asthma (GINA) includes current clinical control and future risk. " Current clinical control” is replaced by " symptom control” in GINA 2015, and lung function is excluded from assessment of current clinical control. This study was designed to investigate the agreement in current asthma control assessment between GINA 2009 and 2015, and to explore whether FEV₁ monitoring plays an important role in this context. Methods A cross-sectional study was conducted among patients with stable asthma (n=138). The levels of asthma control were graded by GINA 2009 and GINA 2015, respectively. Demographic data, spirometry, exacerbations in the past 12 months, peripheral blood cells, induced sputum were collected. Kappa coefficient was used to measure the agreement of the two asthma control tools. Association of the asthma control levels using the two tools with the exacerbations in the past 12 months was examined by Spearman correlations. Additionally, associations of lung function with the exacerbations in the past 12 months were analyzed. Results Agreement in assessing current asthma control between GINA 2009 and 2015 was moderate (Kappa=0.595, P<0.001). Compared with GINA 2009, the patients with well-controlled asthma assessed by GINA 2015 had worse FEV₁%pred [(89.9±12.9)% vs. (79.9±18.2)%, P=0.013], the partly controlled subjects assessed by GINA 2015 had worse asthma control scores in ACQ-6 score (0.8±0.7 vs. 1.1±0.7, P=0.028) and ACT score (20.7±2.5 vs. 19.4±2.5, P=0.007). Furthermore, asthma control levels assessed by either GINA 2015 or 2009 were related to exacerbations in the past 12 months and stronger relationship was presented in GINA 2015 (r=–0.268 for GINA 2015 vs. r=–0.212 for GINA 2009, respectively). In addition, there were no differences in cell counts in induced sputum or peripheral blood or IgE level in peripheral blood in patients with different asthma control levels assessing by GINA 2009 and 2015. Conclusions Our study indicates that it has a moderate agreement of assessing current asthma control between GINA 2015 and 2009. Compared with GINA 2009, absence of FEV₁ monitoring from GINA 2015 would result in worse lung function in well-controlled asthma and worse asthma control scores in partly controlled asthma. Addition of FEV₁ monitoring to GINA 2015 would weaken the relationship between current asthma control and future asthma outcomes, although it didn't reach statistical significance. Our study supports that GINA 2015 lacking lung function monitoring in current asthma control assessment is applicable in clinical practice.

Citation： MA Li, WANG Ji, KANG Deying, ZHANG Hongping, WANG Lei, WANG Gang. Does lung function monitoring play important roles in assessing current asthma control?. Chinese Journal of Respiratory and Critical Care Medicine, 2017, 16(4): 354-366. doi: 10.7507/1671-6205.201611038 Copy

1.	Bousquet J, Clark TJ, Hurd S, et al. GINA guidelines on asthma and beyond. Allergy, 2007, 62(2):102-112.
2.	Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2009. Available at: http://ginasthma.org.
3.	Nathan RA, Sorkness CA, Kosinski M, et al. Development of the Asthma Control Test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1):59-65.
4.	Juniper EF, O’Byrne PM, Guyatt GH, et al. Development and validation of a questionnair to measure asthma control. Eur Respir J, 1999, 14(4):902-907.
5.	Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA)2015.Available at: http://ginasthma.org.
6.	中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(支氣管哮喘的定義、診斷、治療和管理方案). 中華結核和呼吸雜志, 2008, 31(3): 177-185.
7.	Wang G, Zhou T, Wang L, et al. Relationship between current psychological symptoms and future risk of asthma outcomes: a 12-month prospective cohort study. J Asthma, 2011, 48(10): 1041-1050.
8.	Novak N, Bieber T. Allergic and nonallergic forms of atopic diseases. J Allergy Clin Immunol, 2003, 112(2): 252-262.
9.	Marks GB, Dunn SM, Woolcock AJ. A scale for the measurement of quality of life in adults with asthma. J Clin Epidemiol, 1992, 45(5): 461-472.
10.	Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5):948-968.
11.	鄭勁平, 主編. 肺功能學: 基礎與臨床. 廣州: 廣東科技出版社, 2007, 8.
12.	鄭潔, 張欣, 鄭靜, 等. 肥胖與支氣管哮喘控制水平及氣道炎癥表型的關系. 中國呼吸與危重監護雜志, 2015, 14(6):578-584.
13.	Wang G, Baines KJ, Fu JJ, et al. Sputum mast cell subtypes relate to eosinophilia and corticosteroid response in asthma. Eur Respir J, 2016, 47(4):1121-1133.
14.	Simpson JL, Phipps S, Baines KJ, et al. Elevated expression of the NLRP3 inflammasome in neutrophilic asthma. Eur Respir J, 2014, 43(4):1067-1076.
15.	Simpson JL, McElduff P, Gibson PG. Assessment and reproducibility of non-eosinophilic asthma using induced sputum. Respiration, 2010, 79(2):147-151.
16.	Meng XL, Rosenthal R, Rubin DB. Comparing correlated correlation coefficients. Psychol Bull, 1992, 111(1):172-175.
17.	呂媛, 易銀沙. 關聯相關系數的比較. 實用預防醫學, 2001, 8(2): 157-158.
18.	Bailey WC, Higgins DM, Richards BM, et al. Asthma severity: a factor analytic investigation. Am J Med, 1992, 93(3): 263-269.
19.	Rosi E, Ronchi MC, Grazzini M, et al. Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: results of a factor analysis. J Allergy Clin Immunol, 1999, 103(2 Pt 1): 232-237.
20.	Kerstjens HA, Brand PL, de Jong PM, et al. Influence of treatment on peak expiratory flow and its relation to airway hyperresponsiveness and symptoms. The Dutch CNSLD Study Group. Thorax, 1994, 49(11):1109-1115.
21.	Jenkins CR, Thien FC, Wheatley JR, et al. Traditional and patient-centred outcomes with three classes of asthma medication. Eur Respir J, 2005, 26(1): 36-44.
22.	Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J, 2015, 46(3): 579-582.
23.	Li HL, He XL, Liang BM, et al. Anxiety but not depression symptoms are associated with greater perceived dyspnea in asthma during bronchoconstriction. Allergy Asthma Proc, 2015, 36(6):447-457.
24.	Osborne ML, Pedula KL, O’Hollaren M, et al. Assessing future need for acute care in adult asthmatics: the Profile of Asthma Risk Study: a prospective health maintenance organization-based study. Chest, 2007, 132(4): 1151-1161.
25.	Kitch BT, Paltiel AD, Kuntz KM, et al. A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest, 2004, 126(6):1875-1882.
26.	Fuhlbrigge AL, Kitch BT, Paltiel AD, et al. FEV₁ is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol, 2001, 107(1):61-67.
27.	Melter EO, Busse WW, Wenzel SE, et al. Use of the Asthma Control Questionaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol, 2011, 127(1):167-172.
28.	McCoy K, Shade DM, Irvin CG, et al. Predicting episodes of poor asthma control in treated patients with asthma. J Allergy Clin Immunol, 2006, 118(6):1226-1233.
29.	Schatz M, Zeiger RS, Yang SJ, et al. The relationship of asthma impairment determined by psychometric tools to future asthma exacerbations. Chest, 2012, 141(1):66-72.
30.	Wei HH, Zhou T, Wang L, et al. Current asthma control predicts future risk of asthma exacerbation: a 12-month prospective cohort study. Chin Med J, 2012, 125(17):2986-2993.
31.	Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012, 42(5):747-759.
32.	Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA²LEN and AllerGen). Allergy, 2008, 63 Suppl 86:8-160.
33.	Wechsler ME, Kelley JM, Boyd IO, et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med, 2011, 365(2): 119-126.
34.	Lazarus SC, Boushey HA, Fahy JV, et al. Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial. JAMA, 2001, 285(20):2583-2593.
35.	Bateman ED, Reddel HK, Eriksson G, et al. Overall asthma control: the relationship between current control and future risk. J Allergy Clin Immunol, 2010; 125(3): 600-608.
36.	Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicenter, double-blind, placebo-controlled trial. Lancet, 2012, 380(9842): 651-659.
37.	Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med, 2008, 178(3): 218-224.
38.	Volbeda F, Broekema M, Lodewijk ME, et al. Clinical control of asthma associates with measures of airway inflammation. Thorax, 2013, 68(1):19-24.

1. Bousquet J, Clark TJ, Hurd S, et al. GINA guidelines on asthma and beyond. Allergy, 2007, 62(2):102-112.
2. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA) 2009. Available at: http://ginasthma.org.
3. Nathan RA, Sorkness CA, Kosinski M, et al. Development of the Asthma Control Test: a survey for assessing asthma control. J Allergy Clin Immunol, 2004, 113(1):59-65.
4. Juniper EF, O’Byrne PM, Guyatt GH, et al. Development and validation of a questionnair to measure asthma control. Eur Respir J, 1999, 14(4):902-907.
5. Global Strategy for Asthma Management and Prevention, Global Initiative for Asthma (GINA)2015.Available at: http://ginasthma.org.
6. 中華醫學會呼吸病學分會哮喘學組. 支氣管哮喘防治指南(支氣管哮喘的定義、診斷、治療和管理方案). 中華結核和呼吸雜志, 2008, 31(3): 177-185.
7. Wang G, Zhou T, Wang L, et al. Relationship between current psychological symptoms and future risk of asthma outcomes: a 12-month prospective cohort study. J Asthma, 2011, 48(10): 1041-1050.
8. Novak N, Bieber T. Allergic and nonallergic forms of atopic diseases. J Allergy Clin Immunol, 2003, 112(2): 252-262.
9. Marks GB, Dunn SM, Woolcock AJ. A scale for the measurement of quality of life in adults with asthma. J Clin Epidemiol, 1992, 45(5): 461-472.
10. Pellegrino R, Viegi G, Brusasco V, et al. Interpretative strategies for lung function tests. Eur Respir J, 2005, 26(5):948-968.
11. 鄭勁平, 主編. 肺功能學: 基礎與臨床. 廣州: 廣東科技出版社, 2007, 8.
12. 鄭潔, 張欣, 鄭靜, 等. 肥胖與支氣管哮喘控制水平及氣道炎癥表型的關系. 中國呼吸與危重監護雜志, 2015, 14(6):578-584.
13. Wang G, Baines KJ, Fu JJ, et al. Sputum mast cell subtypes relate to eosinophilia and corticosteroid response in asthma. Eur Respir J, 2016, 47(4):1121-1133.
14. Simpson JL, Phipps S, Baines KJ, et al. Elevated expression of the NLRP3 inflammasome in neutrophilic asthma. Eur Respir J, 2014, 43(4):1067-1076.
15. Simpson JL, McElduff P, Gibson PG. Assessment and reproducibility of non-eosinophilic asthma using induced sputum. Respiration, 2010, 79(2):147-151.
16. Meng XL, Rosenthal R, Rubin DB. Comparing correlated correlation coefficients. Psychol Bull, 1992, 111(1):172-175.
17. 呂媛, 易銀沙. 關聯相關系數的比較. 實用預防醫學, 2001, 8(2): 157-158.
18. Bailey WC, Higgins DM, Richards BM, et al. Asthma severity: a factor analytic investigation. Am J Med, 1992, 93(3): 263-269.
19. Rosi E, Ronchi MC, Grazzini M, et al. Sputum analysis, bronchial hyperresponsiveness, and airway function in asthma: results of a factor analysis. J Allergy Clin Immunol, 1999, 103(2 Pt 1): 232-237.
20. Kerstjens HA, Brand PL, de Jong PM, et al. Influence of treatment on peak expiratory flow and its relation to airway hyperresponsiveness and symptoms. The Dutch CNSLD Study Group. Thorax, 1994, 49(11):1109-1115.
21. Jenkins CR, Thien FC, Wheatley JR, et al. Traditional and patient-centred outcomes with three classes of asthma medication. Eur Respir J, 2005, 26(1): 36-44.
22. Reddel HK, Bateman ED, Becker A, et al. A summary of the new GINA strategy: a roadmap to asthma control. Eur Respir J, 2015, 46(3): 579-582.
23. Li HL, He XL, Liang BM, et al. Anxiety but not depression symptoms are associated with greater perceived dyspnea in asthma during bronchoconstriction. Allergy Asthma Proc, 2015, 36(6):447-457.
24. Osborne ML, Pedula KL, O’Hollaren M, et al. Assessing future need for acute care in adult asthmatics: the Profile of Asthma Risk Study: a prospective health maintenance organization-based study. Chest, 2007, 132(4): 1151-1161.
25. Kitch BT, Paltiel AD, Kuntz KM, et al. A single measure of FEV1 is associated with risk of asthma attacks in long-term follow-up. Chest, 2004, 126(6):1875-1882.
26. Fuhlbrigge AL, Kitch BT, Paltiel AD, et al. FEV₁ is associated with risk of asthma attacks in a pediatric population. J Allergy Clin Immunol, 2001, 107(1):61-67.
27. Melter EO, Busse WW, Wenzel SE, et al. Use of the Asthma Control Questionaire to predict future risk of asthma exacerbation. J Allergy Clin Immunol, 2011, 127(1):167-172.
28. McCoy K, Shade DM, Irvin CG, et al. Predicting episodes of poor asthma control in treated patients with asthma. J Allergy Clin Immunol, 2006, 118(6):1226-1233.
29. Schatz M, Zeiger RS, Yang SJ, et al. The relationship of asthma impairment determined by psychometric tools to future asthma exacerbations. Chest, 2012, 141(1):66-72.
30. Wei HH, Zhou T, Wang L, et al. Current asthma control predicts future risk of asthma exacerbation: a 12-month prospective cohort study. Chin Med J, 2012, 125(17):2986-2993.
31. Fitzpatrick S, Joks R, Silverberg JI. Obesity is associated with increased asthma severity and exacerbations, and increased serum immunoglobulin E in inner-city adults. Clin Exp Allergy, 2012, 42(5):747-759.
32. Bousquet J, Khaltaev N, Cruz AA, et al. Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA²LEN and AllerGen). Allergy, 2008, 63 Suppl 86:8-160.
33. Wechsler ME, Kelley JM, Boyd IO, et al. Active albuterol or placebo, sham acupuncture, or no intervention in asthma. N Engl J Med, 2011, 365(2): 119-126.
34. Lazarus SC, Boushey HA, Fahy JV, et al. Long-acting beta2-agonist monotherapy vs continued therapy with inhaled corticosteroids in patients with persistent asthma: a randomized controlled trial. JAMA, 2001, 285(20):2583-2593.
35. Bateman ED, Reddel HK, Eriksson G, et al. Overall asthma control: the relationship between current control and future risk. J Allergy Clin Immunol, 2010; 125(3): 600-608.
36. Pavord ID, Korn S, Howarth P, et al. Mepolizumab for severe eosinophilic asthma (DREAM): a multicenter, double-blind, placebo-controlled trial. Lancet, 2012, 380(9842): 651-659.
37. Haldar P, Pavord ID, Shaw DE, et al. Cluster analysis and clinical asthma phenotypes. Am J Respir Crit Care Med, 2008, 178(3): 218-224.
38. Volbeda F, Broekema M, Lodewijk ME, et al. Clinical control of asthma associates with measures of airway inflammation. Thorax, 2013, 68(1):19-24.

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