Exacerbation risk and characterisation of the UK’s asthma population, from infants to old age

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Title: Exacerbation risk and characterisation of the UK’s asthma population, from infants to old age
Authors: Bloom, CI
Nissen, F
Douglas, IJ
Smeeth, L
Cullinan, P
Quint, JK
Item Type: Journal Article
Abstract: Background Few studies have examined the characteristics of a general asthma population; most have focused on more severe patients or severe exacerbations. Methods This population-based cohort study, from April 2007 to September 2015, used linked primary and secondary care electronic healthcare records (Clinical Practice Research Datalink, Hospital Episode Statistics). Characteristics of four age cohorts, ‘Under 5s’, ‘5 to 17s’, ‘18 to 54s’, ‘55+’, were described. Exacerbation risk factors, including asthma severity (measured by the British Thoracic Society (BTS) stepwise approach), were assessed using Poisson regression. Results 424 326 patients with current asthma were eligible (n, median follow-up: ‘Under 5s’=17 320, 1 year; ‘5 to 17s’=82 707, 3.3 years; ‘18 to 54s’=210 724, 4 years; ‘55+’=113 575, 5.1 years). Over 60% of the total study population had mild asthma (BTS steps 1/2). There were differences between the cohort’s characteristics, including by gender, disease severity and exacerbation pattern. The rate of exacerbations was highest in the oldest cohort and lowest in the ‘5 to 17s’ cohort (rate per 10 person-years (95% CI), ‘Under 5s’=4.27 (4.18 to 4.38), ‘5 to 17s’=1.48 (1.47 to 1.50), ‘18 to 54s’=3.22 (3.21 to 3.24), ‘55+’=9.40 (9.37 to 9.42)). In all cohorts, exacerbation rates increased with increasing asthma severity, after adjusting for confounders including gender, socioeconomic status, smoking, body mass index, atopy, rhinitis, gastro-oesophageal reflux, anxiety, depression and COPD. Conclusion The majority of UK patients with asthma had mild asthma and did not experience an exacerbation during follow-up. Patients aged ≥55 years had the lowest proportion with mild asthma and highest rate of exacerbations; the opposite was found in patients aged between 5 and 18 years.
Issue Date: 19-Mar-2018
Date of Acceptance: 10-Oct-2017
ISSN: 1468-3296
Publisher: BMJ Publishing Group
Start Page: 313
End Page: 320
Journal / Book Title: Thorax
Volume: 73
Copyright Statement: © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.
Keywords: asthma
asthma epidemiology
1103 Clinical Sciences
Respiratory System
Publication Status: Published
Appears in Collections:National Heart and Lung Institute
Faculty of Medicine

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