Comparison of the Proportion and Healthcare Utilisation of Adult Patients with Uncontrolled Severe Asthma versus Non-Severe Asthma Seen in a Southeast Asian Hospital-Based Respiratory Specialist Clinic

Abstract

Introduction: Understanding the burden of uncontrolled severe asthma is essential for disease-targeted healthcare planning. There is a scarcity of data regarding the proportion, healthcare utilisation and costs of patients with uncontrolled severe asthma in Asia. This study aimed to plug the knowledge gap in this area. Materials and Methods: Consecutive patients with asthma managed in our respiratory specialist clinic were evaluated prospectively. Healthcare utilisation comprising unscheduled asthma-related primary care visits, emergency department (ED) visits and hospital admissions were obtained from the national health records system. We defined uncontrolled severe asthma as poor symptom control (Asthma Control Test score <20); 2 or more asthma exacerbations requiring ≥3 days of systemic corticosteroids in the previous year; 1 or more serious asthma exacerbation requiring hospitalisation in the previous year; or airflow limitation with pre-bronchodilator forced expiratory volume in 1 second (FEV1) <80% predicted despite high dose inhaled corticosteroids and another controller medication. Results: Of the 423 study participants, 49 (11.6%) had uncontrolled severe asthma. Compared to non-severe asthma, patients with uncontrolled severe asthma were older and more likely to be female and obese. They had a median of 2 (interquartile range: 0 to 3) exacerbations a year, with 51% having ≥2 exacerbations in the past 12 months. They were responsible for 43.9% of the hospital admissions experienced by the whole study cohort. Mean annual direct asthma costs per patient was S$2952 ± S$4225 in uncontrolled severe asthma vs S$841 ± S$815 in non-severe asthma. Conclusion: Approximately 12% of patients with asthma managed in a hospital-based respiratory specialist clinic in Singapore have uncontrolled severe asthma. They account for a disproportionate amount of healthcare utilisation and costs. Healthcare strategies targeting these patients are urgently needed. Key words: Cost, Exacerbations, Singapore

Strong and graded associations between level of asthma severity and all-cause hospital care use and costs in the UK

“…Even in fully adjusted models, people with mild and moderate-to-severe asthma were estimated to experience a rate of 2.7 and 6.2 times more respiratory hospital admissions compared with those without asthma, respectively. Our results show that asthma burdens secondary care with significantly higher rates of hospital admissions, length of stay and hospital costs compared with the asthma-free population, with more severe disease contributing disproportionately to this burden, mirroring the findings of other studies within the asthma literature 25–28. It is likely, however, that the fully adjusted models in this study underestimate the full effect of asthma on hospital outcomes, since socioeconomic deprivation, smoking, BMI and the comorbidities included here are highly associated with asthma 29.…”

Association of Childhood Atopic Dermatitis With a Higher Risk of Health Care Utilization and Drug Use for Asthma: A Nationwide Cohort Study

“…This indicates that it is difficult to avoid hospital admissions in this group even with regular check-ups and a higher use of asthma medication. Adult patients with asthma have shown that greater utilization rates of asthma medications and health care services are associated with uncontrolled and severe asthma 16,17 . Furthermore, increased disease severity is associated with higher exacerbation frequency, emergency department visits, and hospital admissions 18 .…”

“…Adult patients with asthma have shown that greater utilization rates of asthma medications and health care services are associated with uncontrolled and severe asthma. 16,17 Furthermore, increased disease severity is associated with higher exacerbation frequency, emergency department visits, and hospital admissions. 18 This suggests that children with AD might have an increased risk of uncontrolled asthma or increased asthma severity compared with children without this comorbidity; however, asthma severity was not directly measured in the present study.…”

Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies

“…Three out of ten patients reported not having used any healthcare resource in the year prior to the study, and a considerable proportion of patients (40.8%) did not attend to any routine medical appointment in the same period, which goes against the asthma management recommendations that advocate each patient should have an asthma review at least once a year. 27 Unscheduled medical appointments, [28][29][30] Emergency Department visits (particularly among non-OCS users), 28,30,31 and hospitalizations 29,30,32 were also less frequent than reported by other studies. In fact, only 18% of the participants visited the ED due to asthma in the previous year, a lower proportion than that reported by step 3+ patients using a short-acting beta agonist (SABA) inhaler (45%) in a previous study conducted in Portugal.…”