Study for Treatment Effects and Prognostic Factors of Bronchial Asthma : Follow Up Over 2 Years

Choung, Bo Young; Park, Jung Won; Kim, Sung Kyu; Hong, Chein Soo

Abstract

BACKGROUND
Asthma causes recurrent episodes of wheezing, breathlessness, chest tightness, and cough. These symptoms are usually associated with widespread but variable airflow limitation that is partly reversible either spontaneously or with treatment. The inflammation also causes an associated increase in airway resposiveness to a variety of stimuli. METHOD: Of the 403 adult bronchial asthma patients enrolled from March 1992 to March 1994 in Allergy Clinics of Severance Hospital in Yonsei University, this study reviewed the 97 cases to evaluate the treatment effects and to analyse prognostic factors. The patients were classified to five groups according to treatment responses ; group 1 (non control group) : patients who were not controlled during following up, group 2 (high step treatment group) : patients who were controlled longer than 3 months by step 3 or 4 treatment of 'Global initiative for asthma, Global strategy for asthma management and prevention' (NHLBI/UNO) with PFR(%) larger than 8055, group 3 (short term control group) : patients who were controlled less than 1 year by step 1 or 2 treatment of NHLBI/WHO, group 4 (intermediate term control group) : patients who were controlled for more than 1 year but less than 2 years by step 1 or 2 treatment of NHLBI/HNO, group 5 (long term control group). patients who were controlled for more than 2 years by step 1 or 2 treatment of NHHI/WHO. Especially the patients who were controlled more than 1 year with negatively converted methacholine test and no eosinophil in sputum were classified to methacholine negative conversion group. We reviewed patients' history, atopy score, total IgE, specific IgE, methacholine PC2O and Peripheral blood eosinophil counts pulmonary function test steroid doses and aggrevation numbers after treatment.
RESULTS
On analysis of 98 patients, 20 cases(20.6%) were classified to group 1, 26 cases(26.8%) to group 2, 23 cases(23.7%) to group 3, 15 cases(15.5%) to group 4, and 13 cases(13.4%) to groups 5. There were no differences of sex, asthma type, family history, smoking history, allergic rhinitis and aspirin allergy among the groups. In long term control group, asthma onset age was younger, symptom duration was shorter, and Initial pulmonary function was better. The long term control group required 1ower amounts of oral steroid, had less aggrevation during first 3months after starting treatment and shorter duration from enrollment to control. Atopy, allergic skin tests sputum and blood eosinophil, total IgE, nonspecific bronchial resposiveness was not significantly different among the groups. Seven out of 28 patients who were controlled more than 1 years showed negatively converted methachloine test and no eosinophils in the sputum. The mean control duration was 20.3Î±9.7 months and relapse did not occur.
CONCLUSION
Patients who had asthma of onset age younger, shorter symptom duration better PFT, lower treatment initial steps, lower amounts of steroid needs and less aggravation numbers after starting treatment were classified in the long term control groups compared to the others.