Modeling asthma exacerbations through lung function in children
| Autor: | Steven M. Kymes, Dennis Lambert, Joshua Edler, Dustin Stwalley, Martin H. Gregory, Anne L. Fuhlbrigge, Ann Chen Wu |
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| Rok vydání: | 2012 |
| Předmět: |
Male
medicine.medical_specialty Exacerbation Immunology Administration Oral Placebo Models Biological Article Decision Support Techniques Adrenal Cortex Hormones Health care medicine Humans Multicenter Studies as Topic Immunology and Allergy Computer Simulation Child Intensive care medicine Adverse effect Lung Lung function Randomized Controlled Trials as Topic Asthma Asthma exacerbations business.industry Emergency department Prognosis medicine.disease United States Respiratory Function Tests respiratory tract diseases Hospitalization Emergency medicine Disease Progression Female Emergency Service Hospital business |
| Zdroj: | Journal of Allergy and Clinical Immunology. 130:1065-1070 |
| ISSN: | 0091-6749 |
| DOI: | 10.1016/j.jaci.2012.08.009 |
| Popis: | Background Formal economic evaluation using a model-based approach is playing an increasingly important role in health care decision making. Objective To develop a model by using an objective measure of lung function— prebronchodilator FEV 1 as a percent of predicted (FEV 1 % predicted)—as the primary independent factor to predict the frequency of adverse events related to the exacerbation of asthma on a population level. Methods We developed a Markov simulation model of childhood asthma by using data from the Childhood Asthma Management Program. The primary outcomes were the result of asthma exacerbations defined as hospitalizations, emergency department (ED) visits, and the need for oral corticosteroid therapy. Predicted monthly frequencies for each acute event were based on negative binomial regression equations estimated from the placebo arm of the Childhood Asthma Management Program with covariates of age, prebronchodilator FEV 1 % predicted, time in study, prior hospitalizations, and prior nocturnal awakenings. Results Simulated versus observed mean number of acute events were similar within the placebo and treatment groups. While the trial demonstrated treatment effects of 48% reduction in hospitalizations, 46% reduction in ED visits, and 44% reduction in the need for oral corticosteroid therapy at 48 months, the model simulated similar reductions of 49% in hospitalizations, 41% in ED visits, and 46% in the need for oral corticosteroid therapy. Conclusions Our findings suggest that longitudinal intervention effects may be modeled through FEV 1 % predicted to estimate hospitalizations, ED visits, and need for oral corticosteroid therapy in childhood asthma for planning and evaluation purposes. |
| Databáze: | OpenAIRE |
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