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Measuring exacerbations in obstructive lung disease.
Karin J Velthove1, Patrick C Souverein, Wouter W van Solinge
1Division of Pharmacoepidemiology and Pharmacotherapy, Faculty of Science, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, The Netherlands.
Pharmacoepidemiology and Drug Safety
|December 17, 2009
Summary
Hospitalization underestimates obstructive lung disease exacerbations. Outpatient care and high-dose inhaled corticosteroid (ICS) use predict exacerbations, necessitating careful monitoring for patients on chronic systemic corticosteroids.
Area of Science:
- Pharmacoepidemiology
- Pulmonary Medicine
- Health Services Research
Background:
- Hospitalization is a traditional marker for exacerbations in obstructive lung disease (OLD).
- A shift towards outpatient care may lead to underestimation of disease severity and exacerbation rates.
- Accurate assessment of exacerbation markers is crucial for effective disease management.
Purpose of the Study:
- To quantify the incidence of various exacerbation markers in obstructive lung disease.
- To identify predictors associated with these exacerbation markers.
- To evaluate the impact of outpatient treatment trends on exacerbation measurement.
Main Methods:
- A large cohort study was conducted using the PHARMO record linkage system in the Netherlands.
- Adult users of inhaled corticosteroids (ICS) were identified from 1985 onwards.
- Exacerbations were defined by hospitalization and short courses of systemic corticosteroids.
Main Results:
- Over 5300 patients were analyzed, with over 8600 exacerbations recorded.
- A significant trend towards outpatient management of exacerbations was observed (p=0.003).
- High-dose ICS use (aRR 1.4) and chronic systemic corticosteroid use (aRR 1.9) were significant predictors of exacerbations.
Conclusions:
- Relying solely on hospitalization underestimates the true rate of obstructive lung disease exacerbations.
- Patients using chronic systemic corticosteroids or high-dose ICS are at increased risk.
- Close monitoring of these high-risk patients is essential to prevent detrimental recurrent exacerbations and improve quality of life.
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