Asthma hospitalization increases risk of rehospitalization and death
Published online: May 1, 2021
Many asthma patients still have poor disease control, despite the availability of different efficient treatment options. One recently identified related reason is that many asthma patients extensively use short-acting β2-agonists (SABA) medication, well beyond recommendation. Poor asthma control with severe worsening periods (exacerbations) results not only in impaired quality of life for the patient but also in high costs for society. A recent study by Ekström et al in The Journal of Allergy and Clinical Immunology: In Practice evaluated patterns of management, health care resource utilization, and risk of rehospitalization and death from asthma in asthma patients who had been hospitalized because of an exacerbation.
This was a real-world observational study using national Swedish health registers (patient-, drugs, and cause of death). All asthma patients, 6 years and older, who had been admitted to hospital due to asthma during 2006-2015 were included at the date of their first hospitalization during the study period (index). The patients were followed for subsequent asthma rehospitalizations the following year, use of health care and asthma medications for three years, and death until end of study (up to 10 years). The year before index was used as baseline.
Overall, the study included 15,691 patients, with an average follow-up time of close to 5 years. The mean age was 51 years, 63% were females, and almost half of all patients (42%) had experienced an exacerbation the year before index. During the first year after the initial hospitalization, 12% of the patients were again hospitalized for asthma. Factors that increased the risk of re-hospitalization were being female, older age, presence of other comorbid conditions, more severe disease, and having had an asthma exacerbation the year before. Use of SABA and oral corticosteroids were more common among the rehospitalized patients than those not rehospitalized (73% versus 59%; and 57% versus 38%, respectively). Patients who were rehospitalized also had a close to 3 times higher risk to subsequently die from asthma as well as a slightly higher overall risk of death than patients who were not rehospitalized. Outpatient visits to specialist clinics increased to 36% the first year of follow-up compared to 23% at baseline, but then again decreased to levels comparable to baseline by the third year of follow-up. During each of the 3 years, approximately one third of the asthma patients experienced exacerbations. Dispensing of inhaled corticosteroids increased from 65% at baseline to 86% during the first year, but then declined to 71% by the third year.
This study showed that more than 1 in 10 asthma patients hospitalized due to an asthma exacerbation were rehospitalized for the same reason within a year, and that these patients were more likely to die from any cause and particularly from asthma. Few patients saw a specialist during the years after being hospitalized, and the patients’ asthma medications were often sub-optimal. The authors conclude that a closer monitoring of asthma patients after hospitalization is needed.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.