Factors associated with clinical severity determined by requirement for systemic corticosteroid therapy in adult asthmatic patients

Lee, Keu Sung; Choi, Jung Hee; Choi, Tae Young; Lim, Hong Seok; Cho, Il Hyun; Sin, Seung Soo; Suh, Yu Jin; Lee, Young Mok; Nahm, Dong Ho; Park, Hae Sim

Abstract

BACKGROUND: Most studies involving factor analysis on clinical severity of bronchial asthma are short-term and cross-sectional.
OBJECTIVES
We evaluated the clinical severity of bronchial asthma according to requirement of systemic corticosteroid therapy, and analyzed the factors associated with long-term systemic corticosteroid therapy.
METHODS
The records of 158 asthmatic patients (including 76 patients followed for one year) visiting the clinic of Allergy-Immunology of Ajou University Hospital between June, 1997 and May, 1999 were reviewed retrospectively.
RESULTS
Among the 76 asthmatic patients who had been followed-up for one year, asthmatic patients (n=28) treated with systemic corticosteroid for more than 60 days had lower initial FEV1(% predicted) values (p=0.001), lower prevalence of concomitant allergic diseases (p= 0.04), and lower frequency of allergen-specific immunotherapy (p=0.006) than asthmatic patients treated with systemic corticosteroid for less than 60 days (n=48). Among the 158 asthmatic patients, 87 patients (55%) were atopic asthmatics and 71 patients (45%) were nonatopic asthmatics. Nonatopic asthmatics showed older age at initial visit (p<0.001), lower serum total IgE levels (p=0.02), lower prevalence of concomitant allergic diseases (p=0.004), and higher prevalence of aspirin-sensitivity (p<0.001) than atopic asthmatic patients. Among the 76 patients followed for one year, nonatopic asthmatic patients were treated with significantly higher cumulative-doses of systemic steroid than atopic asthmatic patients (p=0.04).
CONCLUSION
Initial pulmonary function and nonatopy are significantly associated with clinical severity determined by requirement of systemic corticosteroid therapy in adult asthmatic patients.