Abstract
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.
Highlights
Asthma exacerbations are frequent in patients with severe disease
In this report of two large database studies in the US and UK, each involving >200,000 patients with asthma, it was demonstrated that increased disease severity defined by Global Initiative for Asthma (GINA) Step, medication use, and exacerbation history was associated with higher asthma exacerbation frequency
In the current study eosinophil counts were not assessed as a risk factor, it was demonstrated that the proportion of patients experiencing ≥1 exacerbations during the follow-up period was higher in patients who had severe uncontrolled asthma (GINA Step 4/5 plus ≥2 exacerbations in the previous year) with eosinophil counts (≥300 cells/μl) than in patients who did not
Summary
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. In patients with mild-to-moderate asthma, exacerbation frequency can be reduced by maintenance controller therapies such as inhaled corticosteroids (ICS) combined with long-acting β2-agonists (LABA). In patients with severe asthma and persistent symptoms, a 5-year study has shown that exacerbation frequency remains relatively unchanged, despite intensive therapy with ICS/LABA for a minimum of 4 months per year [9]. Healthcare resource utilization (HRU) is reported to be greatest in patients with severe asthma and a history of previous exacerbations, with exacerbations requiring oral corticosteroid (OCS) treatment, and emergency department (ED) visits or hospitalization documented as posing the greatest burden to healthcare systems [2, 12,13,14,15]. The average direct costs per patient are reported to be approximately twice as high in patients with severe uncontrolled asthma compared with those that have non-severe uncontrolled asthma [16]
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