Multivariable prognostic relations of asthma attack risk factors in the ORACLE patient-level meta-analysis

<bold>Rationale:</bold> Risk factors for severe asthma attacks include asthma treatment step, attack history, low lung function, uncontrolled symptoms and type-2 biomarkers blood eosinophil count (BEC) and exhaled nitric oxide (FeNO). However, multivariable prognostic relations remain unclear. <bold>Aim:</bold> To assess the prognostic relationships of baseline risk factors with future severe asthma attacks (defined as ≥3 days systemic steroids). <bold>Methods:</bold> We included 6516 participants from control arms of 22 randomised controlled trials (6-12m follow-up, the OxfoRd Asthma attaCk risk scaLE (ORACLE) patient-level meta-analysis). Rate ratios for the annualised asthma attack rate were derived from 2 negative binomial models: 1) univariable, 2) adjusted for treatment step, attack in past 12m, Asthma Control Questionnaire-5 (ACQ5), FEV<sub>1</sub>%, log<sub>10</sub>BEC and log<sub>10</sub>FeNO. <bold>Results:</bold> Rate ratios for severe asthma attacks in the multivariable model were treatment step (1 <italic>vs</italic> 3), 0.13 [95%CI in Fig]; attack in past 12m (yes/no), 1.94; FEV<sub>1</sub>% (per 10% decrease) 1.11; ACQ5 (per 0.5 increase) 1.10 ; log<sub>10</sub>BEC 1.32; and log<sub>10</sub>FeNO, 1.49 (Fig). <bold>Conclusion:</bold> Asthma treatment step, attack history, lower FEV<sub>1</sub>%, ACQ5, and type-2 biomarkers BEC and FeNO are important risk factors for asthma attacks. Further ORACLE analyses should aim for a prognostic model to support clinical decision-making. <bold>Prospero:</bold> CRD42021245337 <bold>Funding:</bold> NIHR,QRHRN,FRQS,APQ,SAB,LUF <fig><object-id>erj;64/suppl_68/OA3761/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

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Published
2024-09-14
DOI
https://doi.org/10.1183/13993003.congress-2024.oa3761
Primary Topic
Asthma and respiratory diseases
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article
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article

Multivariable prognostic relations of asthma attack risk factors in the ORACLE patient-level meta-analysis

Guy Brusselle, Mario Castro, C.A. Celis-Preciado, Jacob K. Sont et al.
Asthma and respiratory diseases
article

Multivariable prognostic relations of asthma attack risk factors in the ORACLE patient-level meta-analysis

Guy Brusselle, Mario Castro, C.A. Celis-Preciado, Jacob K. Sont, Jonathan Corren, Nicola A. Hanania, Sanjay Ramakrishnan, Timothy Hinks, Fleur L. Meulmeester, Emilio Santoro, Megan Hardin, Chris Compton, Christopher Edward Brightling, Annette Laugerud, Jo Hardy, Richard Beasley, Cécile Holweg, Sarah Diver, Simon Couillard, Xavier Jaumont, Ian Pavord, Ewout W. Steyerberg, Deborah Clarke, Neil Martin, D.J. Jackson, Michael E. Wechsler
article en

Abstract

<bold>Rationale:</bold> Risk factors for severe asthma attacks include asthma treatment step, attack history, low lung function, uncontrolled symptoms and type-2 biomarkers blood eosinophil count (BEC) and exhaled nitric oxide (FeNO). However, multivariable prognostic relations remain unclear. <bold>Aim:</bold> To assess the prognostic relationships of baseline risk factors with future severe asthma attacks (defined as ≥3 days systemic steroids). <bold>Methods:</bold> We included 6516 participants from control arms of 22 randomised controlled trials (6-12m follow-up, the OxfoRd Asthma attaCk risk scaLE (ORACLE) patient-level meta-analysis). Rate ratios for the annualised asthma attack rate were derived from 2 negative binomial models: 1) univariable, 2) adjusted for treatment step, attack in past 12m, Asthma Control Questionnaire-5 (ACQ5), FEV<sub>1</sub>%, log<sub>10</sub>BEC and log<sub>10</sub>FeNO. <bold>Results:</bold> Rate ratios for severe asthma attacks in the multivariable model were treatment step (1 <italic>vs</italic> 3), 0.13 [95%CI in Fig]; attack in past 12m (yes/no), 1.94; FEV<sub>1</sub>% (per 10% decrease) 1.11; ACQ5 (per 0.5 increase) 1.10 ; log<sub>10</sub>BEC 1.32; and log<sub>10</sub>FeNO, 1.49 (Fig). <bold>Conclusion:</bold> Asthma treatment step, attack history, lower FEV<sub>1</sub>%, ACQ5, and type-2 biomarkers BEC and FeNO are important risk factors for asthma attacks. Further ORACLE analyses should aim for a prognostic model to support clinical decision-making. <bold>Prospero:</bold> CRD42021245337 <bold>Funding:</bold> NIHR,QRHRN,FRQS,APQ,SAB,LUF <fig><object-id>erj;64/suppl_68/OA3761/F1</object-id><object-id>F1</object-id><object-id>F1</object-id><graphic></graphic></fig>

AstraZeneca (United Kingdom) (GB), North Bristol NHS Trust (GB), Université de Sherbrooke (CA), University of Leicester (GB), University of California, Los Angeles (US), Baylor College of Medicine (US), GlaxoSmithKline (United Kingdom) (GB), Guy's and St Thomas' NHS Foundation Trust (GB), Leiden University Medical Center (NL), Ghent University Hospital (BE), Nuffield Orthopaedic Centre (GB), National Jewish Health (US), University of Oxford (GB), AVEO Oncology (United States) (US), Prognos (Switzerland) (CH), University of Kansas Medical Center (US), Kaiser Permanente South San Francisco Medical Center (US), Medical Research Institute of New Zealand (NZ), Science Oxford (GB), Institute for Respiratory Health (AU), University of Colorado Denver (US)
Openalex Percentile: Top 72%
Asthma and respiratory diseases
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