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Laurenzo SA, Townsend EA, Lane Starr NM, Wollet LJ, Castro M, Jarjour NN, Sorkness CA, Lee KE, Denlinger LC. Development and Dynamic Responsiveness of the Acute Asthma Exacerbation Survey in Patients With Moderate to Severe Disease. J Allergy Clin Immunol Pract 2023; 11:3425-3434.e4. [PMID: 37453571 PMCID: PMC11000541 DOI: 10.1016/j.jaip.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 07/03/2023] [Accepted: 07/06/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND The recall periods and response scales of existing surveys of asthma control are poorly suited for studying acute exacerbations. OBJECTIVE To develop an instrument able to predict exacerbations after the onset of acute symptoms and with a recall window sufficiently short to study recovery. METHODS We developed the six-item Acute Asthma Exacerbation Survey (AAES). Data were collected at baseline, acute, and recovery visits within an established longitudinal protocol for participants with severe asthma. Participants scheduled acute study visits at the first sign of a cold. Nasal lavage samples and lung function measurements were also collected. The AAES data were analyzed using Cronbach α, Spearman correlations, and Kruskal-Wallace methods. We used logistic regression for predictors of bursts of oral corticosteroids (OCS). RESULTS Of 130 participants studied at baseline, 52 returned for an acute visit. The AAES scores were elevated at the acute visit and returned to baseline after recovery independently of respiratory virus detection. Cronbach α for the AAES was 0.853, 0.822, and 0.889 at the three respective visits. Compared with participants not needing burst OCS, those with exacerbations had higher acute AAES scores (16 [13.5-18] vs 11.5 [8.2-14], median [interquartile range]; P = .017) and a larger reduction from baseline in lung function. For each 3-point increase in AAES scores, the odds ratio for burst OCS use was 1.64 (95% CI, 1.04-2.57; P = .030). CONCLUSIONS The AAES is internally consistent and dynamically responsive during acute asthma exacerbations. Additional validation studies are warranted to support future trials and aid in clinical decision-making.
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Affiliation(s)
- Scott A Laurenzo
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Elizabeth A Townsend
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Nicole M Lane Starr
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Lori J Wollet
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Mario Castro
- Department of Internal Medicine, University of Kansas-Kansas City, Kansas City, Kan
| | - Nizar N Jarjour
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Christine A Sorkness
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis; Pharmacy Practice and Translational Research Division, University of Wisconsin School of Pharmacy, Madison, Wis
| | - Kristine E Lee
- Department of Biostatistics and Medical Informatics, University of Wisconsin School of Medicine and Public Health, Madison, Wis
| | - Loren C Denlinger
- Division of Allergy, Pulmonary, and Critical Care, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wis.
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Laurenzo SA, Kardon R, Ledolter J, Poolman P, Schumacher AM, Potash JB, Full JM, Rice O, Ketcham A, Starkey C, Fiedorowicz JG. Pupillary response abnormalities in depressive disorders. Psychiatry Res 2016; 246:492-499. [PMID: 27821359 PMCID: PMC5161673 DOI: 10.1016/j.psychres.2016.10.039] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2016] [Accepted: 10/19/2016] [Indexed: 10/20/2022]
Abstract
Depressive disorders lack objective physiological measurements to characterize the affected population and facilitate study of relevant mechanisms. The melanopsin-mediated light signaling pathway may contribute to seasonal variation and can be measured non-invasively by pupillometry. We prospectively studied changes in melanopsin-mediated pupillary constriction in 19 participants with major depressive disorder (MDD) and 10 control across the summer and winter solstices. The melanopsin-mediated response, as measured by the pupil's sustained constriction six s after a high intensity blue light stimulus, was marginally attenuated in those with MDD relative to controls (p=0.071). The participants with MDD unexpectedly showed a significantly reduced transient pupillary response to low intensity red (p=0.011) and blue light (p=0.013), but not high intensity red and blue light. Sustained pupillary constriction in response to high intensity blue light was more pronounced with increasing daylight hours (p=0.037) and was more strongly related to objectively measured versus estimated light exposure. Melanopsin-mediated impairments in pupil response may serve as a biological marker for vulnerability to depression in low light conditions. Assessment of these and other responses to light stimuli, such as response to low intensity light, may be useful for the study of the neurobiology of MDD and related mood disorders.
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Affiliation(s)
- Scott A. Laurenzo
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, United States
| | - Randy Kardon
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Johannes Ledolter
- Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States,Tippie College of Business, The University of Iowa, Iowa City, IA 52242, USA
| | - Pieter Poolman
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Ashley M. Schumacher
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, United States
| | - James B. Potash
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, United States
| | - Jan M. Full
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Olivia Rice
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Anna Ketcham
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Cole Starkey
- Department of Ophthalmology, Roy J. and Lucille A. Carver College of Medicine, United States,Iowa City Veterans Affairs center for Prevention of Visual Loss, Department of Veterans Affairs Hospital, United States
| | - Jess G. Fiedorowicz
- Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, United States,Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, United States,Department of Epidemiology, College of Public Health, United States,Corresponding author at: Department of Psychiatry, Roy J. and Lucille A. Carver College of Medicine, United States
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