Characteristics and Outcomes of HEDIS-Defined Asthma Patients with COPD Diagnostic Coding

Zeiger, Robert S.; Schätz, Michael; Li, Qiaowu; Chen, Wansu; Khatry, Deepak; Tran, Trung

doi:10.1016/j.jaip.2015.10.002

Cited by 5 publications

(3 citation statements)

References 19 publications

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“…We found greater asthma-related disease burden also in the subgroup of patients with concomitant COPD and elevated blood eosinophils, as reported by others. 37 The total mean asthma-related costs were similar for the two SUEA populations (those with and without concomitant COPD, £865 and £861, respectively). However, the cost ratio for those with SUEA and concomitant COPD was just 1.6 because of greater total mean costs (£530) for all patients with concomitant COPD, likely because they were older (all ≥40 years) and had more frequent comorbidities.…”

Section: Discussionmentioning

confidence: 85%

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Kerkhof

Tran

Soriano

et al. 2017

Thorax

115

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BackgroundLittle is known about the prevalence of severe, uncontrolled eosinophilic asthma (SUEA) and associated costs.AimsWe sought to determine the prevalence of SUEA and compare asthma-related healthcare resource use (HCRU) and associated costs with overall means for a general asthma population.MethodsThis cohort study evaluated anonymised medical record data (December 1989 through June 2015) from the Clinical Practice Research Datalink and the Optimum Patient Care Research Database to study UK patients with active asthma (diagnostic code and one or more drug prescriptions in the baseline year), aged 5 years and older, without concomitant COPD, and with recorded eosinophil count. SUEA was defined as two or more asthma attacks during 1 baseline year preceding a high blood eosinophil count (≥0.3×109/L) for patients prescribed long-acting β2-agonist (LABA) and high-dosage inhaled corticosteroids (ICS) during baseline plus 1 follow-up year. We compared asthma-related HCRU and associated direct costs (2015 pounds sterling, £) during the follow-up year for SUEA versus the general asthma population.ResultsOf 363 558 patients with active asthma and recorded eosinophil count, 64% were women, mean (SD) age was 49 (21) years; 43% had high eosinophil counts, 7% had two or more attacks in the baseline year and 10% were prescribed high-dosage ICS/LABA for 2 study years. Overall, 2940 (0.81%; 95% CI 0.78% to 0.84%) patients had SUEA. Total mean per-patient HCRU and associated costs were four times greater for SUEA versus all patients (HCRU and cost ratios 3.9; 95% CI 3.7 to 4.1).ConclusionsLess than 1% of patients in a general asthma population had SUEA. These patients accounted for substantially greater asthma-related HCRU and costs than average patients with asthma.

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Section: Discussionmentioning

confidence: 85%

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Kerkhof

Tran

Soriano

et al. 2017

Thorax

115

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“…The meta-analysis of the 5 eligible severe asthma studies reported a median (95% CI) of 285.7 (234.8-347.7) cells/µL; the highest estimate calculated among the meta-analyses. For COPD studies (n=23), all median blood EOS levels were ≥150 cells/µL and <200 cells/µL; 2 of the 23 COPD studies had a higher proportion of females than males [107,109], however neither of these reported median/geometric mean blood EOS counts precluding any interpretation of sex on EOS levels. For the 6 eligible COPD studies, a median (95% CI) of 171.0 (159.1-183.9) cells/µL was reported.…”

Section: Discussionmentioning

confidence: 96%

Blood eosinophil counts in the general population and airways disease: a comprehensive review and meta-analysis

et al. 2021

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BackgroundThe clinical context for using blood eosinophil (EOS) counts as treatment-response biomarkers in asthma and chronic obstructive pulmonary disease (COPD) requires better understanding of EOS distributions and ranges. We describe EOS distributions and ranges published in asthma, COPD, control (non-asthma/COPD) and general populations.MethodsWe conducted a comprehensive literature review and meta-analysis of observational studies (Jan 2008 to Nov 2018) that included EOS counts in asthma, severe asthma, COPD, control and general populations. Excluded studies had total sample sizes <200, EOS as inclusion criterion, hospitalised population only, exclusively paediatric participants.ResultsOverall, 91 eligible studies were identified, most had total-population-level data available: asthma (n=39 studies), severe asthma (n=12 studies), COPD (n=23 studies), control (n=7 studies), general populations (n=14 studies); some articles reported data for multiple populations. Reported EOS distributions were right-skewed (n=7 studies). Reported median EOS counts ranged from: asthma, 157–280 cells·µL−1 (n=22 studies); severe asthma, 200–400 cells·µL−1 (n=8 studies); COPD, 150–183 cells·µL−1 (n=6 studies); controls, 100–160 cells·µL−1 (n=3 studies); general populations, 100–200 cells·µL−1 (n=6 studies). The meta-analysis showed observed variability was mostly between studies rather than within studies. Factors reportedly associated with higher blood EOS counts included: current smoking, positive skin prick test, elevated total IgE, comorbid allergic rhinitis, age ≤18 years, male sex, spirometric asthma/COPD diagnosis, metabolic syndrome and adiposity.ConclusionEOS distribution and range varied by study population, and were affected by clinical factors including age, smoking history and comorbidities which, regardless of severity, should be considered during treatment decision making.

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“…The proportion of all people with "refractory" asthma (asthma that is not responsive to guideline therapies) has been estimated at between 5 and 15% but the contribution of refractory asthma to asthma morbidity and mortality is considerably greater, as the most severe 20% of asthma cases account for 80% of asthma morbidity and health care costs [3]. If patients with the "overlap syndrome" (asthma and COPD) are included, the numbers of people with refractory disease increases significantly [75]. Of the various novel therapies under consideration for refractory asthma [76], macrolides appear to be one of the most promising.…”

Section: Treatmentmentioning

confidence: 99%

Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolides

Webley

Hahn

2017

Respir Res

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Asthma is a chronic respiratory disease characterized by reversible airway obstruction and airway hyperresponsiveness to non-specific bronchoconstriction agonists as the primary underlying pathophysiology. The worldwide incidence of asthma has increased dramatically in the last 40 years. According to World Health Organization (WHO) estimates, over 300 million children and adults worldwide currently suffer from this incurable disease and 255,000 die from the disease each year. It is now well accepted that asthma is a heterogeneous syndrome and many clinical subtypes have been described. Viral infections such as respiratory syncytial virus (RSV) and human rhinovirus (hRV) have been implicated in asthma exacerbation in children because of their ability to cause severe airway inflammation and wheezing. Infections with atypical bacteria also appear to play a role in the induction and exacerbation of asthma in both children and adults. Recent studies confirm the existence of an infectious asthma etiology mediated by Chlamydia pneumoniae (CP) and possibly by other viral, bacterial and fungal microbes. It is also likely that early-life infections with microbes such as CP could lead to alterations in the lung microbiome that significantly affect asthma risk and treatment outcomes. These infectious microbes may exacerbate the symptoms of established chronic asthma and may even contribute to the initial development of the clinical onset of the disease. It is now becoming more widely accepted that patterns of airway inflammation differ based on the trigger responsible for asthma initiation and exacerbation. Therefore, a better understanding of asthma subtypes is now being explored more aggressively, not only to decipher pathophysiologic mechanisms but also to select treatment and guide prognoses. This review will explore infection-mediated asthma with special emphasis on the protean manifestations of CP lung infection, clinical characteristics of infection-mediated asthma, mechanisms involved and antibiotic treatment outcomes.

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Characteristics and Outcomes of HEDIS-Defined Asthma Patients with COPD Diagnostic Coding

Cited by 5 publications

References 19 publications

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Healthcare resource use and costs of severe, uncontrolled eosinophilic asthma in the UK general population

Blood eosinophil counts in the general population and airways disease: a comprehensive review and meta-analysis

Infection-mediated asthma: etiology, mechanisms and treatment options, with focus on Chlamydia pneumoniae and macrolides

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