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Incidence, risk factors and re-exacerbation rate of severe asthma exacerbations in a multinational, multidatabase
Marjolein Engelkes1, Esme J Baan1, Maria A J de Ridder1
1Medical Informatics, ErasmusMC, Rotterdam, The Netherlands.
Insights
Real-world data show severe asthma exacerbations (SAE) are common in children, especially those with prior SAE. Preventing SAE in pediatric asthma is crucial to reduce hospitalizations and disease burden.
Area of Science:
- Pediatric Pulmonology
- Real-world Evidence
- Asthma Epidemiology
Background:
- Limited real-world data exist on severe asthma exacerbations (SAE) in children.
- This study addresses the incidence and risk factors for SAE in pediatric asthma patients.
Purpose of the Study:
- To assess the incidence of severe asthma exacerbations (SAE) in children.
- To identify risk factors associated with SAE in pediatric asthma.
- To evaluate the incidence of asthma-related rehospitalization in children.
Main Methods:
- A multinational cohort study of 212,060 children aged 5-17 years across six European countries (2008-2013).
- Severe asthma defined as high-dose inhaled corticosteroids plus a second controller.
- SAE defined by systemic corticosteroids, emergency department visits, or hospitalization for asthma.
Main Results:
- SAE rates varied from 17 to 198 per 1000 patient-years, highest in severe asthma with prior exacerbations.
- Prior SAE (IRR 3-45) and younger age were significant risk factors for SAE.
- Rehospitalization rates reached up to 79% within one year for severe asthma patients.
Conclusions:
- Real-world SAE rates are highest in children with severe asthma and a history of exacerbations.
- A significant proportion of severe asthma patients experience rehospitalization within a year.
- Focusing on SAE prevention is critical for managing pediatric asthma and reducing its impact.
Background:
There are sparse real-world data on severe asthma exacerbations (SAE) in children. This multinational cohort study assessed the incidence of and risk factors for SAE and the incidence of asthma-related rehospitalization in children with asthma.
Methods:
Asthma patients 5-17 years old with ≥1 year of follow-up were identified in six European electronic databases from the Netherlands, Italy, the UK, Denmark and Spain in 2008-2013. Asthma was defined as ≥1 asthma-specific disease code within 3 months of prescriptions/dispensing of asthma medication. Severe asthma was defined as high-dosed inhaled corticosteroids plus a second controller. SAE was defined by systemic corticosteroids, emergency department visit and/or hospitalization all for reason of asthma. Risk factors for SAE were estimated by Poisson regression analyses.
Results:
The cohort consisted of 212 060 paediatric asthma patients contributing to 678 625 patient-years (PY). SAE rates ranged between 17 and 198/1000 PY and were higher in severe asthma and highest in severe asthma patients with a history of exacerbations. Prior SAE (incidence rate ratio 3-45) and younger age increased the SAE risk in all countries, whereas obesity, atopy and GERD were a risk factor in some but not all countries. Rehospitalization rates were up to 79% within 1 year.
Conclusions:
In a real-world setting, SAE rates were highest in children with severe asthma with a history of exacerbations. Many severe asthma patients were rehospitalized within 1 year. Asthma management focusing on prevention of SAE is important to reduce the burden of asthma.
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