Abstract

BackgroundLittle is known about the real1world characteristics of asthma patients with exacerbations or their pharmacotherapeutic management. We described the sociodemographic and clinical characteristics, and the patterns of short and long-term management of asthma attacks, in a population-wide cohort of exacerbators in the region of Valencia, Spain.MethodsWe selected asthma patients with at least one exacerbation in 2015 and 2016, we classified them according to their patterns of exacerbations in the 4 years previous to the index exacerbation and their therapeutic step at baseline based on medication received in the previous year. We described the short and long-term pharmacological management of the index exacerbation.Results18,714 patients experienced at least one exacerbation. The majority had no previous exacerbation (46.5%), or exacerbated in only one of the years (26.8%). 2.9% had attacks every single year, 25.7% of whom only received rescue medication at baseline. 29.5% of patients without previous exacerbation received maintenance therapy at baseline. Shortly following the index exacerbation, 2,461 patients (13.1%) did not receive any asthma prescription. Among those treated, 70.3% were prescribed a maintenance therapy, 62.4% received a rescue medication, and 30.5% received an oral corticoid. Throughout the year following the index exacerbation, most patients remained in their baseline therapeutic step.ConclusionsMost patients that exacerbate present very mild to mild forms of the disease or low levels of treatment and most exacerbations are managed in primary care. These insights may help to refine strategies for improving asthma control in the population.

Highlights

  • Asthma is a chronic, long-term condition that causes intermittent inflammation and narrows the airways in the lungs, causing periods of wheezing, chest tightness, shortness of breath, and coughing

  • The aim of this study is to describe the sociodemographic and clinical characteristics of patients with asthma and exacerbations, and the patterns of short and long-term pharmacotherapeutic management of asthma attacks, based on a population-wide cohort of all patients with asthma exacerbations in the region of Valencia

  • This population-based cohort study was conducted in the Valencia Health System (VHS), a comprehensive structure of hospitals, primary care facilities, and other public resources managed by the Valencian regional government in Spain providing free, universal healthcare services to 97% of the region’s population

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Summary

Introduction

Long-term condition that causes intermittent inflammation and narrows the airways in the lungs, causing periods of wheezing, chest tightness, shortness of breath, and coughing. Asthma affects people of all ages and often starts during childhood, and symptoms, which may range from mild to severe, may present rarely or daily. It is called an asthma attack or exacerbation (GEMA, 2019). Recent estimations indicate that asthma is responsible for 1.1% of disability-adjusted life years (DALYs) worldwide (GBD 2016 DALYs and HALE Collaborators, 2017). From 1990 to 2015, global prevalence rose 12.6% and it is estimated that currently it affects 258.2 million people in the world, and roughly 10% of the European population (Bahadori et al, 2009). Little is known about the real1world characteristics of asthma patients with exacerbations or their pharmacotherapeutic management. We described the sociodemographic and clinical characteristics, and the patterns of short and long-term management of asthma attacks, in a population-wide cohort of exacerbators in the region of Valencia, Spain

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