Major comorbid conditions in asthma and association with asthma-related hospitalizations and emergency department admissions in adults: results from the German national health telephone interview survey (GEDA) 2010

BMC Pulmonary Medicine

Thomas Keil¹  Christa Scheidt-Nave³  Ute Langen³  Henriette Steppuhn² 

[1] Institute for Clinical Epidemiology and Biometry, University of Würzburg, Joseph-Schneider-Str. 2, D-97070 Würzburg, Germany;Institute for Social Medicine, Epidemiology and Health Economics, Charité - Universitätsmedizin Berlin, Luisenstrasse 57, D-10117 Berlin, Germany;Department of Epidemiology and Health Monitoring, Robert Koch Institute Berlin, General-Pape-Strasse 62-66, D-12101 Berlin, Germany

关键词: National health survey;    Hospitalization;    Gastroesophageal reflux;    Gastroesophageal reflux disease;    Asthma;    Aspirin-induced asthma;    Allergic rhinitis;    Adult;    Acetylsalicylic acid exacerbated respiratory disease;   

Others  :  1109770
DOI  :  10.1186/1471-2466-13-46

 received in 2013-01-08, accepted in 2013-07-05,  发布年份 2013

【 摘 要 】

Background

It remains unclear to what extent asthma in adults is linked to allergic rhinitis (AR), gastroesophageal reflux disease (GERD), and acetylsalicylic acid exacerbated respiratory disease (AERD), and how these comorbidities may affect asthma outcomes in the general population. We therefore aimed to assess the prevalence of these major comorbidities among adults with asthma and examine their impact on asthma exacerbations requiring hospital care.

Methods

A total of 22,050 adults 18 years and older were surveyed in the German National Health Telephone Interview Survey (GEDA) 2010 using a highly standardized computer-assisted interview technique. The study population comprised participants with self-reported physician-diagnosed asthma, among which the current (last 12 months) prevalence of AR and GERD-like symptoms (GERS), and life-time prevalence of AERD was estimated. Weighted bivariate analyses and logistic regression models were applied to assess the association of each comorbid condition with the asthma outcome (any self-reported asthma-related hospitalization and/or emergency department (ED) admission in the past year).

Results

Out of 1,136 adults with asthma, 49.6% had GERS and 42.3% had AR within the past 12 months; 14.0% met the criteria of AERD, and 75.7% had at least one out of the three conditions. Overall, the prevalence of at least one exacerbation requiring emergency room or hospital admission within the past year was 9.0%. Exacerbation prevalence was higher among participants with comorbidities than among those without (9.8% vs. 8.2% for GERS; 11.2% vs. 7.6% for AR, and 22.2% vs. 7.0% for AERD), but only differences in association with AERD were statistically significant. A strong association between asthma exacerbation and AERD persisted in multivariable logistic regression analyses adjusting for sex, age group, level of body mass index, smoking status, educational attainment, and duration of asthma: odds ratio (OR) = 4.5, 95% confidence interval (CI) = 2.5–8.2.

Conclusions

Data from this large nation-wide study provide evidence that GERS, AR and AERD are all common comorbidities among adults with asthma. Our data underline the public health and clinical impact of asthma with complicating AERD, contributing considerably to disease-specific hospitalization and/or ED admission in a defined asthma population, and emphasize the importance of its recognition in asthma care.

【 授权许可】

   
2013 Steppuhn et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Hommers L, Ellert U, Scheidt-Nave C, Langen U: Factors contributing to conductance and outcome of specific immunotherapy: data from the German National Health Interview and Examination Survey 1998. Eur J Public Health 2007, 17:278-284.
• [2]Braman SS: The global burden of asthma. Chest 2006, 130(Suppl 1):4S-12S.
• [3]Bahadori K, Doyle-Waters MM, Marra C, Lynd L, Alasaly K, Swiston J, FitzGerald JM: Economic burden of asthma: a systematic review. BMC Pulm Med 2009, 9:24. BioMed Central Full Text
• [4]Boulet LP, Boulay ME: Asthma-related comorbidities. Expert Rev Respir Med 2011, 5:377-393.
• [5]Boulet LP: Influence of comorbid conditions on asthma. Eur Respir J 2009, 33:897-906.
• [6]Global Initiative for Asthma (GINA): Global strategy for asthma management and prevention. 2011. http://ginasthma.org/ webcite
• [7]Bousquet J, Khaltaev N, Cruz AA, Denburg J, Fokkens WJ, Togias A, Zuberbier T, Baena-Cagnani CE, Canonica GW, Van Weel C, Agache I, Ait-Khaled N, Bachert C, Blaiss MS, Bonini S, Boulet LP, Bousquet PJ, Camargos P, Carlsen KH, Chen Y, Custovic A, Dahl R, Demoly P, Douagui H, Durham SR, Van Wijk RG, Kalayci O, Kaliner MA, Kim YY, Kowalski ML, et al.: Allergic Rhinitis and its Impact on Asthma (ARIA) 2008 update (in collaboration with the World Health Organization, GA(2)LEN and AllerGen). Allergy 2008, 63(Suppl 86):8-160.
• [8]Price D: Asthma and allergic rhinitis: Linked in treatment and outcomes. Ann Thorac Med 2010, 5:63-64.
• [9]Shaaban R, Zureik M, Soussan D, Neukirch C, Heinrich J, Sunyer J, Wjst M, Cerveri I, Pin I, Bousquet J, Jarvis D, Burney PG, Neukirch F, Leynaert B: Rhinitis and onset of asthma: a longitudinal population-based study. Lancet 2008, 372:1049-1057.
• [10]Thomas M: Allergic rhinitis: evidence for impact on asthma. BMC Pulm Med 2006, 6(Suppl 1):4. BioMed Central Full Text
• [11]Bousquet J, Gaugris S, Kocevar VS, Zhang Q, Yin DD, Polos PG, Bjermer L: Increased risk of asthma attacks and emergency visits among asthma patients with allergic rhinitis: a subgroup analysis of the investigation of montelukast as a partner agent for complementary therapy [corrected]. Clin Exp Allergy 2005, 35:723-727.
• [12]Price D, Zhang Q, Kocevar VS, Yin DD, Thomas M: Effect of a concomitant diagnosis of allergic rhinitis on asthma-related health care use by adults. Clin Exp Allergy 2005, 35:282-287.
• [13]Bundesärztekammer (BÄK), Kassenärztliche Bundesvereinigung (KBV), Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF): Nationale VersorgungsLeitlinie Asthma – Langfassung, 2. Auflage. Version 1.3. 2011. http://www.versorgungsleitlinien.de/themen/asthma webcite
• [14]Brozek JL, Bousquet J, Baena-Cagnani CE, Bonini S, Canonica GW, Casale TB, Van Wijk RG, Ohta K, Zuberbier T, Schunemann HJ: Global Allergy Asthma European Network; Grading of Recommendations Assessment, Development and Evaluation Working Group: Allergic Rhinitis and its Impact on Asthma (ARIA) guidelines: 2010 revision. J Allergy Clin Immunol 2010, 126:466-476.
• [15]Cazzola M, Calzetta L, Bettoncelli G, Novelli L, Cricelli C, Rogliani P: Asthma and comorbid medical illness. Eur Respir J 2011, 38:42-49.
• [16]Havemann BD, Henderson CA, El-Serag HB: The association between gastro-oesophageal reflux disease and asthma: a systematic review. Gut 2007, 56:1654-1664.
• [17]McCallister JW, Parsons JP, Mastronarde JG: The relationship between gastroesophageal reflux and asthma: an update. Ther Adv Respir Dis 2011, 5:143-150.
• [18]Kiljander TO, Junghard O, Beckman O, Lind T: Effect of esomeprazole 40 mg once or twice daily on asthma: a randomized, placebo-controlled study. Am J Respir Crit Care Med 2010, 181:1042-1048.
• [19]Lee RU, Stevenson DD: Aspirin-exacerbated respiratory disease: evaluation and management. Allergy, Asthma & Immunology Research 2011, 3:3-10.
• [20]Palikhe NS, Kim JH, Park HS: Update on recent advances in the management of aspirin exacerbated respiratory disease. Yonsei Med J 2009, 50:744-750.
• [21]Stevenson DD, Szczeklik A: Clinical and pathologic perspectives on aspirin sensitivity and asthma. J Allergy Clin Immunol 2006, 118:773-786.
• [22]Mascia K, Haselkorn T, Deniz YM, Miller DP, Bleecker ER, Borish L: Aspirin sensitivity and severity of asthma: evidence for irreversible airway obstruction in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol 2005, 116:970-975.
• [23]Bavbek S, Celik G, Demirel YS, Misirligil Z: Risk factors associated with hospitalizations for asthma attacks in Turkey. Allergy Asthma Proc 2003, 24:437-442.
• [24]Bavbek S, Yilmaz I, Celik G, Aydin O, Erkekol FO, Orman A, Kurt E, Ediger D, Dursun B, Abadoglu O, Ozseker F, Akkaya E, Karakis GP, Canbakan S, Yuksel S, Misirligil Z: Prevalence of aspirin-exacerbated respiratory disease in patients with asthma in Turkey: a cross-sectional survey. Allergol Immunopathol 2012, 40:225-230.
• [25]Jenkins C, Costello J, Hodge L: Systematic review of prevalence of aspirin induced asthma and its implications for clinical practice. BMJ 2004, 328:434.
• [26]Gaugris S, Sazonov-Kocevar V, Thomas M: Burden of concomitant allergic rhinitis in adults with asthma. J Asthma 2006, 43:1-7.
• [27]Reddel HK, Taylor DR, Bateman ED, Boulet LP, Boushey HA, Busse WW, Casale TB, Chanez P, Enright PL, Gibson PG, De Jongste JC, Kerstjens HA, Lazarus SC, Levy ML, O’Byrne PM, Partridge MR, Pavord ID, Sears MR, Sterk PJ, Stoloff SW, Sullivan SD, Szefler SJ, Thomas MD, Wenzel SE, American Thoracic Society/European Respiratory Society Task Force on Asthma Control and Exacerbations: An official American Thoracic Society/European Respiratory Society statement: asthma control and exacerbations: standardizing endpoints for clinical asthma trials and clinical practice. Am J Respir Crit Care Med 2009, 180:59-99.
• [28]Kurth BM, Lange C, Kamtsiuris P, Holling H: Health monitoring at the Robert Koch Institute. Status and perspectives. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2009, 52:557-570.
• [29]Gabler S, Haeder S: Idiosyncrasies in Telephone Sampling - The Case of Germany. International Journal of Public Opinion Research 2002, 14:339-345.
• [30]Salmon CT, Nichols JS: The Next-Birthday Method of Respondent Selection. Public Opin Q 1983, 47:270-276.
• [31]Robert Koch-Institut: Daten und Fakten: Ergebnisse der Studie “Gesundheit in Deutschland aktuell 2010”. Beiträge zur Gesundheitsberichterstattung des Bundes. Berlin: RKI; 2012.
• [32]Centers for Disease Control and Prevention (CDC): Behavioral Risk Factor Surveillance System. http://www.cdc.gov/brfss/ webcite
• [33]World Health Organisation: Obesity and Overweight. Fact Sheet N.311. http://www.who.int/mediacentre/factsheets/fs311/en/ webcite
• [34]Schroedter JH, Lechert Y, Lüttinger P: Die Umsetzung der Bildungsskala ISCED-1997 für die Volkszählung 1970, die Mikrozensus- Zusatzerhebung 1971 und die Mikrozensen 1976–2004. ZUMA-Methodenbericht. 2006/08. Mannheim: ZUMA; 2006.
• [35]Eisner MD, Iribarren C: The influence of cigarette smoking on adult asthma outcomes. Nicotine Tob Res 2007, 9:53-56.
• [36]Scheidt-Nave C, Kamtsiuris P, Gosswald A, Holling H, Lange M, Busch MA, Dahm S, Dolle R, Ellert U, Fuchs J, Hapke U, Heidemann C, Knopf H, Laussmann D, Mensink GB, Neuhauser H, Richter A, Sass AC, Rosario AS, Stolzenberg H, Thamm M, Kurth BM: German health interview and examination survey for adults (DEGS) - design, objectives and implementation of the first data collection wave. BMC Publ Health 2012, 12:730. BioMed Central Full Text
• [37]Du Y, Heidemann C, Gosswald A, Schmich P, Scheidt-Nave C: Prevalence and comorbidity of diabetes mellitus among non-institutionalized older adults in Germany - results of the national telephone health interview survey ‘German Health Update (GEDA)’ 2009. BMC Publ Health 2013, 13:166. BioMed Central Full Text
• [38]Lehtonen R, Pakinen E: Practical Method for Design and Analyses of Complex Surveys. 2nd edition. Chichester: John Wiley and Sons; 2004.
• [39]Hermann-Kunz E: Allergic diseases in Germany. Bundesgesundheitsbl - Gesundheitsforsch - Gesundheitsschutz 2000, 43:400-406.
• [40]Kasper L, Sladek K, Bochenek G, Duplaga M, Szczeklik A: The frequency of hypersensitivity to non-steroidal anti-inflammatory drugs (NSAIDs) in the population of adult asthmatics in Poland based on an epidemiological questionnaire. Pneumonol Alergol Pol 2009, 77:431-439.
• [41]Hedman J, Kaprio J, Poussa T, Nieminen MM: Prevalence of asthma, aspirin intolerance, nasal polyposis and chronic obstructive pulmonary disease in a population-based study. Int J Epidemiol 1999, 28:717-722.
• [42]Vally H, Taylor ML, Thompson PJ: The prevalence of aspirin intolerant asthma (AIA) in Australian asthmatic patients. Thorax 2002, 57:569-574.
• [43]Sims EJ, Price D, Haughney J, Ryan D, Thomas M: Current control and future risk in asthma management. Allergy, Asthma & Immunology Research 2011, 3:217-225.
• [44]Hutter N, Knecht A, Baumeister H: Health care costs in persons with asthma and comorbid mental disorders: a systematic review. Gen Hosp Psychiatry 2011, 33:443-453.
• [45]Littner MR, Leung FW, Ballard ED II, Huang B, Samra NK, Lansoprazole Asthma Study Group: Effects of 24 weeks of lansoprazole therapy on asthma symptoms, exacerbations, quality of life, and pulmonary function in adult asthmatic patients with acid reflux symptoms. Chest 2005, 128:1128-1135.
• [46]Peters S: The impact of comorbid atopic disease on asthma: clinical expression and treatment. J Asthma 2007, 44:149-161.
• [47]Kanani AS, Broder I, Greene JM, Tarlo SM: Correlation between nasal symptoms and asthma severity in patients with atopic and nonatopic asthma. Ann Allergy Asthma Immunol 2005, 94:341-347.
• [48]Ring J: Weißbuch Allergie in Deutschland 2000. 2nd edition. München: Urban &Vogel Verlag; 2004.
• [49]Bousquet J, Van Cauwenberge P, Khaltaev N, Aria Workshop Group; World Health Organisation: Allergic rhinitis and its impact on asthma. J Allergy Clin Immunol 2001, 108(5):147-334.
• [50]Kilpelainen M, Terho EO, Helenius H, Koskenvuo M: Validation of a new questionnaire on asthma, allergic rhinitis, and conjunctivitis in young adults. Allergy 2001, 56:377-384.