A territory‐wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong

Abstract

Background: The real-world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective: To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods: A territory-wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed.Results: There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0-81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma-associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively)This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

Recurrent events analysis with piece-wise exponential additive mixed models

“…Some concrete examples include recurrence of hospitalization for cardiovascular events [1,2], recurrent diseases and infections like COVID-19 [3], pneumonia [4,5], pneumococcus [6], staphylococcus aureus (cf. section Example 1: Staphylococcus aureus infection data) [7,8], asthma [9,10] and malaria (cf. section Example 2: Childhood malaria data) [11][12][13].…”

“…Some concrete examples include recurrence of hospitalization for cardiovascular events (Gibson et al, 2017; Varma et al, 2021), recurrent diseases and infections like COVID-19 (Dos Santos et al, 2021), pneumonia (Ramjith et al, 2021; Barakat et al, 2021), pneumococcus (Hernstadt et al, 2020), staphylococcus aureus (cf. Section 5.1) (Akinboyo et al, 2018; Abdulgader et al, 2019), asthma (Chan et al, 2021; Feng et al, 2021) and malaria (cf. Section 5.2) (Lawpoolsri et al, 2019; Ghosh et al, 2020; Kakuru et al, 2020).…”

The burden of systemic corticosteroid use in asthma management in Asia

“…2,69,73 For example, a recent study from India estimated that only 6.8%-10.3% of patients with asthma who were indicated for ICS-based regimens were actually prescribed them, 74 while a study from Hong Kong showed that only 64.5% of patients hospitalized for asthma exacerbations had received ICS prior to hospitalization, and a lack of ICS use was determined as a significant predictor of increased asthma-related hospital admissions. 75 In Singapore, a similar trend was observed that suggested association between poor guideline adherence and increased frequency of asthma-related ED readmissions. 73 The extent of guideline adherence appears to be related to the proper care coordination and specialist referrals noted above, as studies have suggested that PCPs/GPs are more likely to prescribe SCS and less likely to prescribe ICS than respiratory specialists.…”

“…• HCPs may not be familiar with the recently detailed risks of SCS in patients with asthma, [23][24][25][26][27][28][29][30][31] or recent asthma treatment guideline updates discouraging the use of SCS. [73][74][75] • Physicians may overestimate patient asthma control, 76 which could lead to prescribing inadequate treatments and, thus, more rapid disease progression and/or exacerbations that require SCS.…”

“…Another clinician‐related factor that may contribute to high SCS use in Asia is poor adherence to asthma treatment guidelines that recommend delaying the use of SCS until after other approaches (e.g., inhaled formulations or biologic therapies) have been deemed ineffective 2,69,73 . For example, a recent study from India estimated that only 6.8%–10.3% of patients with asthma who were indicated for ICS‐based regimens were actually prescribed them, 74 while a study from Hong Kong showed that only 64.5% of patients hospitalized for asthma exacerbations had received ICS prior to hospitalization, and a lack of ICS use was determined as a significant predictor of increased asthma‐related hospital admissions 75 . In Singapore, a similar trend was observed that suggested association between poor guideline adherence and increased frequency of asthma‐related ED readmissions 73 .…”