Analysis on the standardized management of hospitalized asthmatic patients: a single center 10-years experience

Abstract

Objective: To analyze the outcome of standardized management on the hospitalized asthmatic patients in the past 10 years in a single center. Methods: Clinical data of 2 207 asthmatic patients, who were hospitalized in the Center of Respiratory Medicine and Allergic Diseases, the General Hospital of Northern Military District from January 1, 2008 to December 31, 2017, was retrospectively collected and analyzed. Results: Asthmatic in-patients accounted for 11.5% of total hospitalized patients(2 207/19 134) over the 10-year study period. The highest percentage of asthmatic patients over the total hospitalized patients (16.9%, 207/1 223) was in the year 2008, and it was gradually reduced from 2009 through 2017: a median of 13.2% (221/1 674) from 2009 to 2013 with 3.7% decrease, and a median of 9.4% (224/2 385) from 2014 to 2017 with 7.5% decrease. There was a significant difference in the percentages between the year of 2008 (16.9%) and the years from 2009 through 2017 (P<0.05). Over the 10-year study period, 69.1% (1 526/2 207) of the asthmatic in-patients were hospitalized only once, 13.3% (294/2 207) were twice, and 3.8% (85/2 207) were hospitalized more than twice. Totally 1,553 patients were hospitalized with acute asthmatic attack, which accounted for 8.1% (1 553/19 134) of the total in-patient number over the 10 years, and 14.2% (174/1 223) of which was in the year 2008, while 9.7% (163/1 674) was in the years from 2009 through 2013 with a decrease of 4.5% from 2008, and 5.9% (141/2 385) was in 2014 through 2017 with a decrease of 8.3% from 2008. The differences between the 2008 incidence and that of 2009-2013 or 2014-2017 were statistically significant (P<0.05). However, the incidence of acute exacerbation of comorbid conditions was lowest in 2008 (15.9%, 33/207), while it was 25.8% (58/221) from 2009 to 2013 with an increase of 9.9% from 2008, and 37.0% (83/224) from 2013 to 2017 with an increase of 21.1% compared to 2008. Asthmatic hospitalization peaked in March (9.2%, 150/1 628) and August (9.7%, 157/1 612), respectively, while it was lowest in February (7.1%,101/1 423). The difference between the peak months (March and August) and February was statistically significant (P<0.05), while there was no significant difference between February and the rest of months (P>0.05). When the risk factors for acute asthmatic attack was analyzed by grouping single-time attack (n=1 074) versus multiple-time attack (hospitalized ≥ 2 times, n=479), we found the following risk factors were significant: airway infection (OR=2.006), male (OR=1.355), age ≥ 65 years old (OR=1.364), wet rales on physical examination (OR=1.762), hospitalization ≥ 14 days (OR=1.892), and invasive mechanical ventilation (OR=1.798). In addition, there were significant differences in per capital cost comparison between the following pairs (P<0.05): multiple-time (16 219±16 628, n=681) vs single-time asthmatic hospitalization (13 752±20 692, n=1 526), multiple-time (13 933±13 036, n=479) vs single-time hospitalization with acute asthmatic attack (11 208±13 853, n=1 074), multi-time asthmatic hospitalization (n=681) vs multi-time hospitalization with acute asthmatic attack (n=479), and single-time asthmatic hospitalization (n=1 526) vs single-time hospitalization with acute asthmatic attack (n=1 074). Conclusions: Standardized management of asthma could significantly reduce the risk of hospitalization as well as acute asthmatic attack. Findings of the current study suggested that risk factors for acute and recurrent asthmatic attack should be assessed and managed efficiently in order to reduce incidence of multiple hospitalization for asthma.