Burden of asthma in the hospital setting: an Australian analysis

Abstract

Summary Objectives: This study was designed to report factors associated with asthma hospital admission, such as patient characteristics, type of admission and subsequent outcome i.e. discharge or death, for the years 2000–2005. These data are used for health economic models regarding asthma burden in the hospital setting in Australia. Methods: Data was obtained from the Australian Centre for Asthma Monitoring using their amalgamated dataset from all states and territories. Admissions under ICD‐10 codes J45 ‘Asthma’ plus all subcodes, and J46 ‘acute severe asthma’ were included. Codes for associated comorbidity at the time of admission were identified, as well as the month of death, age, gender and length and the type of stay. Confidence intervals for death rate assumed a binomial distribution because of the rarity of event. Results: The total number of all‐cause deaths for the 5‐year observation period was 289 from 202,739 asthma separations or 0.14% or 143 deaths/100,000 separations and the highest rate was seen in patients over 45 years. Acute upper respiratory tract infections were reported in up to 25% of all asthma hospital admissions. Length of stay was up to a mean average of 10.2 days in patients who died (SD 15.3). In 5 years observation there was 152,758 emergency asthma admissions which contributed greatly to Australian healthcare burden. Conclusions: The study demonstrates that emergency admissions dominate asthma care in the hospital setting in Australia, which suggests poor asthma control in some patients with subsequent economic burden. Asthma‐related mortality remains a risk for specific patients in the hospital setting.

Modelling and predicting low count child asthma hospital readmissions using General Additive Models

“…Even on a per-month aggregate basis, the counts were as low as 2. Runs of consecutive zero readmission days were as long as 54 days for boys' and 48 days for girls' readmissions with respective inter quartile ranges and median (IQR) of (1,3,5) and (2,4,7). Consecutive zero readmission days for total readmissions had IQR (1, 2, 3) with a maximum length of 27 days.…”

“…We also included 95% error limits around the predictions. We constructed our graphs using either the Lattice package [30] in the open source language R, version 2.13 [5] or just using the usual plot functions in R, and Stata 10.1 (Statacorp, USA). All of the GAMs were fitted using the MGCV package in R [29].…”

“…In Australia, children aged 0 -14 years account for 58% of total asthma admissions [2]. Asthma hospital readmissions attract disproportionate amounts of resources from healthcare systems worldwide [3,4], including in Australia [5]. Asthma readmissions are an indicator of asthma severity, psychological comorbidity, the effectiveness of hospital and community health services and also developments in hospital admission criteria, diagnostic practice and/or emergency department management [6].…”

Influences of meteorological parameters and biological and chemical air pollutants on the incidence of asthma and rhinitis

“…Rimpela et al (1995) describe a 3-fold increase of physiciandiagnosed asthma and allergic rhinitis among Finnish adolescents in the period from 1977 to 1991. Studies indicate that asthma and allergic conditions are most prevalent in the UK (Canonica et al 2007), Australia (Watson et al 2007) and New Zealand (Epton et al 2007). An increasing trend of respiratory symptoms has also been reported for Chile (Luque et al 2006).…”

Use of Early Extra-Corporeal Membrane Oxygenation (ECMO) for Severe Refractory Status Asthmaticus

“…Despite improvements in asthma therapy, hospitalisation for exacerbation of asthma remains common and mortality after admission to critical care is substantial [1,2]. Mechanical ventilation for respiratory failure due to asthma is a life saving intervention and is currently the treatment of choice [3].…”