Exacerbations of asthma - A descriptive study of 425 severe exacerbations

The identification, prevention, and prompt treatment of exacerbations are m ajor objectives of asthma management. We looked at change in PEF, symptoms, and use of rescue p-agonists during the 425 severe exacerbations that occu rred during a 12-mo parallel group study (FACET) in which low and high dose s of budesonide with and without formoterol were compared in patients with asthma. Oral corticosteroids were prescribed for severe exacerbations, the main study end point, defined as the need for a course of oral corticostero ids (n = 311) or a reduction in morning PEF of > 30% on two consecutive day s. PEF, symptoms, and bronchodilator use over the 14 d before and after the exacerbation were obtained from diary cards. Exacerbations were characteri zed by a gradual fall in PEF over several days, followed by more rapid chan ges over 2 to 3 d; an increase in symptoms and rescue p-agonist use occurre d in parallel, and both the severity and time course of the changes were si milar in all treatment groups. Exacerbations identified by the need for ora l corticosteroids were associated with more symptoms and smaller changes in PEF than those identified on the basis of PEF criteria. Female sex was the main patient characteristic associated with an increased risk of having a severe exacerbation. Exacerbations may be characterized predominantly by ch ange in symptoms or change in PEF, but the pattern was not affected by the dose of inhaled corticosteroid or by whether the patient was taking formote rol.