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International Variation in Severe Exacerbation Rates in Patients With Severe Asthma
Tae Yoon Lee1, David Price2, Chandra Prakash Yadav3
1Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Respiratory Evaluation Sciences Program, Faculty of Pharmaceutical Sciences, University of British Columbia, Canada.
Chest
|February 23, 2024
Summary
Severe asthma exacerbation rates vary significantly between countries, even after accounting for patient factors. This highlights the need for jurisdiction-specific risk prediction and tailored disease management strategies.
Area of Science:
- Pulmonology
- Epidemiology
- Health Services Research
Background:
- Exacerbation frequency is a critical determinant of treatment decisions in severe asthma management.
- Understanding international variations in exacerbation rates is essential for effective global disease control.
Purpose of the Study:
- To quantify the extent of variability in severe asthma exacerbation rates across different countries.
- To explore the implications of this variability for asthma disease management and treatment strategies.
Main Methods:
- Data from the International Severe Asthma Registry (ISAR) cohort of biologic-naive severe asthma patients (≥18 years) were analyzed.
- Severe exacerbations were defined as oral corticosteroid use (≥3 days) or asthma-related hospitalization/ED visits.
- Country-specific exacerbation rates were estimated using negative binomial models, with adjustments for patient and disease characteristics.
Main Results:
- The study included 7,510 patients from 17 countries, with 56% from the United States.
- A significant between-country variation in observed severe exacerbation rates was found (IQR: 0.13-0.54), ranging from 0.04 in Argentina to 0.88 in Saudi Arabia.
- This variability persisted even after adjusting for patient characteristics and sampling variability (IQR: 0.16-0.39).
Conclusions:
- Significant differences in severe asthma exacerbation risk exist between countries, even among patients with similar characteristics.
- These disparities suggest the influence of unmeasured patient-level factors or systemic variations in healthcare delivery.
- Disease management guidelines and risk prediction models require jurisdictional calibration to optimize severe asthma treatment.
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