Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study Bradley E.

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Presentation transcript:

Key findings and clinical implications from The Epidemiology and Natural History of Asthma: Outcomes and Treatment Regimens (TENOR) study Bradley E. Chipps, MD, Robert S. Zeiger, MD, PhD, Larry Borish, MD, Sally E. Wenzel, MD, Ashley Yegin, MD, Mary Lou Hayden, MS, FNP-C, AE-C, Dave P. Miller, MS, Eugene R. Bleecker, MD, F. Estelle R. Simons, MD, Stanley J. Szefler, MD, Scott T. Weiss, MD, MS, Tmirah Haselkorn, PhD Journal of Allergy and Clinical Immunology Volume 130, Issue 2, Pages 332-342.e10 (August 2012) DOI: 10.1016/j.jaci.2012.04.014 Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 1 TENOR study design. *Daily high doses of inhaled steroids were defined by the American Thoracic Society refractory asthma guidelines for adults5 and by the NHLBI guidelines for children.6 AEs, Adverse events. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 2 Rates of HCU by number of long-term controller medications in patients aged 6 to 11 years (left panel), 12-17 years (center panel), and 18 or more years (right panel). Long-term controllers included ICSs, long-acting β-agonists, leukotriene modifiers, methylxanthines, and cromolyn sodium or nedocromil. No statistically significant differences were found in rates of HCU by number of long-term controllers in children and adolescents; *P < .01 for all HCU measures in adults except history of intubation, which was not significant.7 Adapted from Chipps et al,7 Copyright (2007), with permission from Elsevier. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig 3 Risk of asthma exacerbations at the month 30 visit associated with consistently VPC asthma, as defined by the impairment domain of the NHLBI guidelines. Final adjusted models for hospitalizations and ED visits include prior hospitalizations or ED visits, number of long-term controllers, BMI, allergic triggers, nonallergic triggers, percent predicted FVC, race/ethnicity, and age. Final adjusted models for corticosteroid bursts include prior corticosteroid burst, chronic obstructive pulmonary disease, nonallergic triggers, percent predicted FEV1/FVC ratio, race/ethnicity, and age.30 Reprinted from Haselkorn et al,30 Copyright (2009), with permission from Elsevier. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E1 Physician assessment of treatment difficulty. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E2 Least mean square difference and 95% confidence intervals (low-dose salmeterol/fluticasone combination [SFC] minus never-on-SFC: high-dose SFC minus never-on-SFC) in mean Mini Asthma Quality of Life Questionnaire (miniAQLQ) overall scores at 24 months. #Baseline differences between treatment groups, including severity differences, were adjusted with propensity scores; ¶quality of life (QoL) 0.40, P = .0015; +QoL 0.20, P = .0456; §QoL 0.23, P = .0672; ƒQoL 0.01, P = .8915. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions

Fig E3 Least mean square difference and 95% confidence intervals (low-dose salmeterol/fluticasone combination [SFC] minus never-on-SFC; high-dose SFC minus never-on-SFC) in mean Asthma Therapy Assessment Questionnaire (ATAQ) scores at 24 months. #Baseline differences between treatment groups, including severity differences, were adjusted with propensity scores; ¶asthma control −0.46, P < .0001; +asthma control −0.33, P = .0018; §asthma control 0.18, P =.1328; ƒasthma control −0.04, P = .7428. Journal of Allergy and Clinical Immunology 2012 130, 332-342.e10DOI: (10.1016/j.jaci.2012.04.014) Copyright © 2012 American Academy of Allergy, Asthma & Immunology Terms and Conditions