BackgroundAsthma is a chronic inflammatory lung disease that affects 18.7 million U.S. adults. Electronic health records (EHRs) are a unique source of information that can be leveraged to understand factors associated with asthma in real-life populations. In this study, we identify demographic factors and comorbidities associated with asthma exacerbations among adults according to EHR-derived data and compare these findings to those of epidemiological studies.MethodsWe obtained University of Pennsylvania Hospital System EHR-derived data for asthma encounters occurring between 2011 and 2014. Regression analyses were performed to model asthma exacerbation frequency as explained by age, sex, race/ethnicity, health insurance type, smoking status, body mass index (BMI) and various comorbidities. We analyzed data from the National Health and Nutrition Examination Survey (NHANES) from 2001 to 2012 to compare findings with those from the EHR-derived data.ResultsBased on data from 9068 adult patients with asthma, 33.37% had at least one exacerbation over the four-year study period. In a proportional odds logistic regression predicting number of exacerbations during the study period (levels: 0, 1–2, 3–4, 5+ exacerbations), after controlling for age, race/ethnicity, sex, health insurance type, and smoking status, the highest odds ratios (ORs) of significantly associated factors were: chronic bronchitis (2.70), sinusitis (1.50), emphysema (1.39), fluid and electrolyte disorders (1.35), class 3 obesity (1.32), and diabetes (1.28). An analysis of NHANES data showed associations for class 3 obesity, anemia and chronic bronchitis with exacerbation frequency in an adjusted model controlling for age, race/ethnicity, sex, financial class and smoking status.ConclusionsEHR-derived data is helpful to understand exacerbations in real-life asthma patients, facilitating design of detailed studies and interventions tailored for specific populations.Electronic supplementary materialThe online version of this article (10.1186/s40733-019-0048-y) contains supplementary material, which is available to authorized users.

BackgroundAsthma, a chronic respiratory disease affecting over 18.7 million American adults, has marked disparities by gender, race/ethnicity and socioeconomic status. Our goal was to identify gender-specific demographic and socioeconomic determinants of asthma prevalence among U.S. adults using data from the Behavioral Risk Factors Surveillance System (BRFSS) and the National Health and Nutrition Examination Survey (NHANES).MethodsGender-specific regression analyses were performed to model the relationship between asthma prevalence with age, race/ethnicity, income, education level, smoking status, and body mass index (BMI), while taking into account the study designs.ResultsBased on BRFSS data from 1,003,894 respondents, weighted asthma prevalence was 6.2% in males and 10.6% in females. Asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese women was 2.5 and 3.5 times higher, respectively, while that in men was 1.7 and 2.4 times higher; asthma prevalence among current vs. never smoker women was 1.4 times higher, while that in men was 1.1 times higher. Similar results were obtained with NHANES data from 13,364 respondents: asthma prevalence among grade 2 obese and grade 3 obese vs. not overweight or obese respondents was 2.0 and 3.3 times higher for women, though there was no significant difference for men; asthma prevalence among current vs. never smokers was 1.8 times higher for women and not significantly different in men. Asthma prevalence by race/ethnicity and income levels did not differ considerably between men and women.ConclusionsOur results underscore the importance of obesity and smoking as modifiable asthma risk factors that most strongly affect women.Electronic supplementary materialThe online version of this article (doi:10.1186/s40733-017-0030-5) contains supplementary material, which is available to authorized users.

Background Exposure to fine particulate matter (PM2.5) increases the risk of asthma exacerbations, and thus, monitoring personal exposure to PM2.5 may aid in disease self-management. Low-cost, portable air pollution sensors offer a convenient way to measure personal pollution exposure directly and may improve personalized monitoring compared with traditional methods that rely on stationary monitoring stations. We aimed to understand whether adults with asthma would be willing to use personal sensors to monitor their exposure to air pollution and to assess the feasibility of using sensors to measure real-time PM2.5 exposure. Methods We conducted semi-structured interviews with 15 adults with asthma to understand their willingness to use a personal pollution sensor and their privacy preferences with regard to sensor data. Student research assistants used HabitatMap AirBeam devices to take PM2.5 measurements at 1-s intervals while walking in Philadelphia neighborhoods in May–August 2018. AirBeam PM2.5 measurements were compared to concurrent measurements taken by three nearby regulatory monitors. Results All interview participants stated that they would use a personal air pollution sensor, though the consensus was that devices should be small (watch- or palm-sized) and light. Patients were generally unconcerned about privacy or sharing their GPS location, with only two stating they would not share their GPS location under any circumstances. PM2.5 measurements were taken using AirBeam sensors on 34 walks that extended through five Philadelphia neighborhoods. The range of sensor PM2.5 measurements was 0.6–97.6 μg/mL (mean 6.8 μg/mL), compared to 0–22.6 μg/mL (mean 9.0 μg/mL) measured by nearby regulatory monitors. Compared to stationary measurements, which were only available as 1-h integrated averages at discrete monitoring sites, sensor measurements permitted characterization of fine-scale fluctuations in PM2.5 levels over time and space. Conclusions Patients were generally interested in using sensors to monitor their personal exposure to PM2.5 and willing to share personal sensor data with health care providers and researchers. Compared to traditional methods of personal exposure assessment, sensors captured personalized air quality information at higher spatiotemporal resolution. Improvements to currently available sensors, including more reliable Bluetooth connectivity, increased portability, and longer battery life would facilitate their use in a general patient population.

Exposure to fine particulate matter (PM 2.5 ) increases the risk of asthma exacerbations, and thus, improved measurements of personal exposure to PM 2.5 may aid in disease self-management. Traditional methods for estimating personal PM 2.5 exposure often rely on measurements taken at regulatory monitoring stations, such as those operated by the

Asthma exacerbations, episodes of worsening symptoms requiring additional treatment, are a major source of asthma morbidity and healthcare costs. Disparities in exacerbations by race/ethnicity, sex, and income are known in the U.S., especially for African Americans, Puerto Ricans, women and those with low incomes. Several environmental factors, including cigarette smoke, mold, and dust mites, have been associated with asthma exacerbations. Decreasing exposure to such triggers, as well as improving disease self-management skills, are known to decrease asthma exacerbations. However, the relationship among demographic, environmental, and self-management factors in the U.S. is not fully understood. We used results from a national phone-based survey to better understand the factors that may contribute to disparities in asthma exacerbations. METHODS: Asthma Call-Back Survey (ACBS) data from 2014 and 2015 corresponding to 23,741 respondents from 32 states and Puerto Rico was obtained (https://www.cdc.gov/brfss/annual_data/annual_data.htm). Exacerbations were defined as an affirmative response to a question of "having visited the ED or urgent care because of asthma at least once in the past 12 months." Logistic regression models with exacerbations as outcome and various demographic, environmental and selfmanagement factors as predictors were created with the R Survey package, while considering survey design. RESULTS: Consistent with previous studies, female sex, black race/ethnicity, low income, and obese body mass index (BMI) were significantly associated with increased exacerbations. In terms of asthma self-management, people with exacerbations in the previous year were more likely to have had various interventions related to recognizing symptoms, having an asthma action plan, and learning what to do during an asthma attack (Table ). Most (20,443/21,499; 95%) respondents received inhaler technique guidance, which was not associated with exacerbations. Results to questions related to environmental factors found that persons with exacerbations were more likely to have been advised to change things in home, use mattress and pillow covers to control dust mites and have an air cleaner. According to unadjusted analyses, household mold and smoking inside the home were the most prominent environmental factors associated with exacerbations. CONCLUSIONS: Persons with asthma exacerbations in the prior year had increased interventions that are appropriate to decrease exacerbations, with mold and smoking in the home being the most noticeable potential triggers. Longitudinal studies are necessary to determine whether the listed self-management strategies, as well as interventions to decrease exposure to mold and smoke in the home, have a sustained impact on decreasing future exacerbations.