Asthma exacerbation remains prevalent among today's asthmatics despite ready treatments and therapies. A majority of current asthma scoring systems evaluate degree of asthma control without reference to level of asthma controller therapy. Thus, a child with good control on a high level of medication would have the same score as a child with good control on little or no controller. As previously developed by the Inner-City Asthma Consortium for the Asthma Control Evaluation (ACE) study, a Comprehensive Asthma Burden Index (CABI) combines asthma control, level of controller medication, and health care utilization in order to more comprehensively characterize asthma severity. Developing a better scoring system for asthma therapy will materially aid physicians and other caregivers in deciding how closely to follow patients and, potentially, when to modify the treatment plan. This study is currently open. We aim to recruit approximately 100 patients from the greater Tucson area by their primary care physicians and other clinical physicians. Potential participants will by ages 6-17 (inclusive) and have asthma. They will not be pregnant, be a smoker, or have had life-threatening asthma. Following screening, participants will be administered four characterization indices: the Asthma Control Questionnaire (ACT), CABI, exhaled nitric oxide (eNO), and CABIN (CABI + eNO). Following this first visit, participants who experience an asthma attack over the next 18 months will contact the pulmonary outpatient clinic at University Physicians, where they will receive testing related to their asthma. This visit will also include the four characterization indices. Participants will then be scheduled for a convalescence visit 2 weeks following the exacerbation visit. Chi-squared analysis with odds ratios for the outcomes will be calculated based upon a priori cut points in the indices. The primary outcome variable is the occurrence of an exacerbation in the 18-month observation period. We assume that the asthma indices being explored cannot plausibly have an inverse relationship to our primary and secondary outcomes. We anticipate an increase in risk for exacerbations of three fold, ie, an odds ratio of 3.0 in the highest index tertile as compared against the lower 2 tertiles. Our calculated need of 100 participants was based on this information as well as a target of 80% power and alpha level of 0.05.
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