Before hospital admission for an exacerbation, asthma patients don't look alike!

Abstract

Background: In view of optimizing asthma care, improved characterization of hospitalized patients would be helpful. More specifically, it would be of interest to identify the patterns of use of controller therapy related to exacerbations that lead to hospital admissions, their distribution, and subjects9 characteristics. Objectives: To identify distinct patterns of therapy used by asthma patients before hospital admission, and to study patients characteristics within distinct patterns. Methods: Using a 1/97 th random sample of the French claims data, asthma patients aged 6-40 years were identified with ≥3 dispensations of asthma medications in a 12-month period from 2006 to 2014. Patients with asthma-related hospitalization (T0) were selected. Based on controller therapy patterns in the 12 months before T0, subjects were categorized in treatment profiles, using Ward9s minimum-variance hierarchical clustering method. Results: We identified 275 patients with asthma-related hospitalization. Three distinct treatment profiles were identified. The first group (61.2%) included patients with low exposure to controller medication. The 2nd group (34.7%) gathered patients with high exposure to long-acting beta agonists (LABA)/inhaled corticosteroids (ICS) in fixed-dose combinations. The third group (4.1%) comprised patients receiving free combination of ICS and LABA, with twice more units of LABA than ICS. Conclusions: In France, before an asthma-related hospitalization, >60% of patients were not treated by controller therapy and >4% were exposed to periods of LABAs in monotherapy. Concerns are raised about the current use of asthma treatments, as subjects are exposed to serious, but preventable, exacerbations.