A territory‐wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong

Immunity, Inflammation and Disease

Mo Lin Maureen Wong¹  Kwok Sang Wilson Yee²  Cee Zhung Steven Tseng²  Yu Hong Chan³  Pik Shan Cheung⁴  Lee Veronica Chan⁴  Kwun Cheung Ling⁵  Ka Pang Chan⁵  Fanny Wai San Ko⁵  Christopher Kei Wai Lai⁵  Chung Tat Lun⁶  Sheng Sheng Ho⁶  Wai Kei Lam⁷  Chun Man Wong⁷  Kah Lin Choo⁷  Yi Tat Lo⁸  Chun Kong Ng⁹  Macy Mei‐sze Lui^1,10  Pak Yiu Tse^1,11 

[1] Department of Medicine & Geriatrics Caritas Medical Centre Hong Kong China;Department of Medicine & Geriatrics Kwong Wah Hospital Hong Kong China;Department of Medicine & Geriatrics Princess Margaret Hospital Hong Kong China;Department of Medicine & Geriatrics United Christian Hospital Hong Kong China;Department of Medicine & Therapeutics Chinese University of Hong Kong Hong Kong China;Department of Medicine Alice Ho Miu Ling Nethersole Hospital Hong Kong China;Department of Medicine North District Hospital Hong Kong China;Department of Medicine Pamela Youde Nethersole Eastern Hospital Hong Kong China;Department of Medicine Queen Elizabeth Hospital Hong Kong China;Department of Medicine The University of Hong Kong Hong Kong China;Department of Medicine Tseung Kwan O Hospital Hong Kong China;

关键词: asthma (clinical aspects);    asthma clinical care;    asthma control;    asthma exacerbations;    asthma outcomes research;   

DOI  :  10.1002/iid3.419

来源: DOAJ

【 摘 要 】

Abstract Background The real‐world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods A territory‐wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed. Results There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0–81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma‐associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively) for asthma exacerbation in the preceding year, the presence of neuropsychiatric (IRR: 1.142) and gastrointestinal (IRR: 1.154) comorbidities were risk factors for an increasing number of admissions for asthma exacerbation. For patients with ≥2 admissions, 17.1% were not prescribed inhaled corticosteroid and only 44.6% had spirometry checked before the index admission. Asthma phenotyping was often incomplete, as assessment of atopy (total serum immunoglobulin E level and senitization to aeroallergens) was only performed in 30 (5.8%) patients with ≥2 admissions. Conclusions and Clinical Relevance Improving asthma care, especially in elderly patients with a prior history of urgent healthcare utilization and comorbidities, may help reduce healthcare burden. Suboptimal management before the index admission was common in patients hospitalized for asthma exacerbations. Early identification of patients at risk and enhancement of baseline asthma management may help to prevent recurrent asthma exacerbation and subsequent hospitalization.

【 授权许可】

Unknown