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BMC Pulmonary Medicine

, 17:74

Asthma and allergic disorders


BackgroundAsthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department ED-hospital re-admissions, and asthma-related costs by asthma severity in the US and UK.

MethodsPatients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT 2010–2011; WEUSKOP7048 and the UK-based Clinical Practice Research Datalink 2009–2011; WEUSKOP7092 databases were categorized by disease severity Global Initiative for Asthma GINA; Step and exacerbation history during the 12 months pre-asthma medical code index date. Outcomes included: frequency of exacerbations asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks 12 months post-index, asthma-related ED visits-hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model.

ResultsOf the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit-hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32–35% for an exacerbation requiring ED visit-hospitalization versus oral corticosteroids.

ConclusionIncreased disease severity was associated with higher exacerbation frequency, ED-hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management.

KeywordsExacerbation Healthcare utilization Electronic medical records Claims database Severe uncontrolled asthma Severe eosinophilic asthma AbbreviationsBTSBritish Thoracic Society

CIConfidence interval

CPRDClinical Practice Research Datalink

EDEmergency department

GINAGlobal Initiative for Asthma

HESHospital Episode Statistics

HRHazard ratio

HRUHealthcare resource utilization

ICSInhaled corticosteroid

IgEImmunoglobulin E

LABALong-acting β2-agonist

LTRALeukotriene receptor antagonist

N-ANot applicable

NRNot referenced

OCSOral corticosteroid

SABAShort-acting β2-agonist

SDStandard deviation

Electronic supplementary materialThe online version of this article doi:10.1186-s12890-017-0409-3 contains supplementary material, which is available to authorized users.

Autor: Robert Y. Suruki - Jonas B. Daugherty - Nada Boudiaf - Frank C. Albers


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