Factors associated with hospital admission in adult patients with asthma exacerbations: A systematic review

Arrotta, Nicholas; Hill, Jesse; Villa‐Roel, Cristina; Dennett, Elizabeth; Harries, Molly; Rowe, Brian H.

doi:10.1080/02770903.2018.1424189

Cited by 10 publications

(11 citation statements)

References 20 publications

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“…Several studies have reported that older asthma patients utilize more healthcare, including more emergency care treatment and hospitalizations. 4,24 Even though sex was not revealed to be a risk factor for asthmarelated hospitalizations in the present study, a previous systematic review identi ed female sex as a signi cant predictor of repeated hospital visits in asthmatic children. 5 We reported that low educational attainment was a signi cant risk factor for asthma-related hospitalization, which was in line with the ndings of several previous studies.…”

Section: Discussioncontrasting

confidence: 73%

“…Research from the developed world has studied possible risk factors, such as disease severity, inadequate clinical care, poor adherence to treatment, the presence of comorbidities, familial factors, behavioral factors and environmental risk factors 4,5, and has shown that older age (> 45 years), female sex, increased disease severity, previous exacerbations requiring hospitalization, overuse of beta agonists, tobacco smoke and asthma comorbidities, such as chronic rhinitis and gastroesophageal re ux disease (GORD), are associated with hospitalizations due to exacerbated asthma. 4,6,7 However, the existing evidence from developed countries is not generalizable to Sri Lankan asthma patients due to differences in sociodemographic background, lifestyle, and healthcare provision.…”

Section: Introductionmentioning

confidence: 99%

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Risk factors for hospitalization due to exacerbations among adult asthma patients in a district of Sri Lanka: a case‒control study.

Punyadasa,

Kumarapeli,

Senaratne

2024

Preprint

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Background The exacerbation of asthma is a leading contributor to hospitalization. Information on the risk factors for hospitalization due to exacerbated asthma will help to identify high-risk asthma patients for specialized care. We aimed to identify the risk factors for hospitalization due to exacerbations among adult asthma patients in a district of Sri Lanka. Methods A hospital-based, case‒control study was carried out on asthma patients aged ≥ 20 years. A total of 466 asthma patients (116 cases, 350 controls) were recruited from all tertiary care hospitals in the district. The data were collected by pre-intern medical officers via a pretested interviewer-administered questionnaire on asthma control, asthma comorbidities, risk behaviors, and physiological and sociodemographic factors. Risk factors were evaluated using bivariate and multivariate logistic regression. The data were analyzed using SPSS version 20. Results The risk factors were age ≥ 60 years (OR 2.1; 95% CI 1.2–3.7), educated G.C.E. O/level or less (OR 2.2; 95% CI 1.1–4.4), having diabetes mellitus (OR 2.0; 95% CI 1.1–3.7), having symptomatic gastroesophageal reflux disease (GORD) (OR 3.4; 95% CI 1.8–6.4), exposure to vehicular traffic (OR 3.2; 95% CI 1.8–5.7), exposure to secondhand tobacco smoke (OR 2.1; 95% CI 1.2–3.5), having ever smoked (OR 2.4; 95% CI 1.2–4.6), ever intubated/given ICU care (OR 3.5; 95% CI 1.5-8.0), previous hospitalizations due to exacerbations (OR 5.5; 95% CI 2.6–11.4), having uncontrolled asthma (OR 3.4; 95% CI 1.6–7.1) and having a BMI ≥ 25 kg/m2 (OR 2.3; 95% CI 1.4-4.0). Conclusions Preventive strategies need to address the modifiable risk factors smoking and obesity and manage comorbid conditions, diabetes, and symptomatic GORD appropriately in asthma patients.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Risk factors for hospitalization due to exacerbations among adult asthma patients in a district of Sri Lanka: a case‒control study.

Punyadasa,

Kumarapeli,

Senaratne

2024

Preprint

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“…Asthma attacks severe enough to require hospital admission often indicate poor management of modifiable risk factors, including comorbidities. 7 8 Several risk factors for asthma attacks have been described separately in children and adults including female sex, 9 10 11 12 a history of previous asthma-related hospital admissions, 10 13 higher disease severity, 14 older age, 9 12 belonging to an ethnic minority group, 13 15 having a history of inhaled corticosteroid use, 15 and presence of comorbidities such as allergic rhinitis, gastro-oesophageal reflux disease and obesity. 11 16 However, risk factors contributing to asthma attacks have not been studied across paediatric and adult populations simultaneously in a large population representative sample.…”

Section: Introductionmentioning

confidence: 99%

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents, and adults: a cohort study using primary and secondary care data

Simms-Williams

Haroon

Nagakumar

et al. 2022

Preprint

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Objectives To assess the association between demographic and clinical risk factors and asthma-related hospital and intensive care admissions in children, adolescents, and adults, and to estimate the proportion of hospital admissions attributable to modifiable risk factors. Design Cohort study using routinely collected primary and secondary care data. Setting A large UK-based primary care database, the Clinical Practice Research Datalink (CPRD) Aurum, and linked Hospital Episode Statistics Admitted Patient Care (HES APC) data. Participants Patients were eligible for the study if they were aged five years and older and had an asthma diagnosis with linked data to the HES APC database. This included 90,989 children aged 5-11 years, 114,927 adolescents aged 12-17 years, and 1,179,410 adults aged 18 years or older. Primary and secondary outcome measures Primary outcome: asthma-related hospital admissions recorded from 1st January 2017 to 31st December 2019. Secondary outcome: asthma-related intensive care unit (ICU) admissions. Incidence rate ratios (IRR) adjusted for demographic and clinical risk factors were estimated using negative binomial models. Population attributable fraction (PAF) amongst those with asthma was estimated for modifiable risk factors that were statistically significantly associated with the primary outcome. Results In children, the risk factors for asthma-related hospital admission were belonging to an ethnic minority group, increasing socioeconomic deprivation, allergies (PAF 11.4%, 95% CI 6.8 to 15.8), and atopic eczema (6.8%, 3.6 to 9.9). In adolescents, the risk factors were being female, belonging to an ethnic minority group, increasing socioeconomic deprivation, former smoking (PAF 6.8%, 0.9 to 12.3), and allergic rhinitis. In adults, the risk factors were younger age, being female, belong to an ethnic minority group, increasing socioeconomic deprivation, being underweight, overweight or obese (PAF 23.3%, 95% CI 20.5 to 26.1 for obesity), current smoking (4.3%, 3.0 to 5.7), depression (11.1%, 9.1 to 13.1), allergies (6.2%, 4.4 to 8.0), gastro-oesophageal reflux disease (2.3%, 1.2 to 3.4), anxiety (2.0%, 0.5 to 3.6), and chronic rhinosinusitis (0.8%, 0.3 to 1.3%). In all age groups, increasing medication burden was associated with an increased risk in the primary outcome. Risk factors for asthma-related ICU admissions in children were black or mixed ethnicity and high levels of socioeconomic deprivation; in adolescents, they were female sex and black ethnicity; and in adults, they were younger age, female sex, black, mixed, or Asian ethnicity, and depression. In all age groups, increasing medication burden was associated with an increased risk in the secondary outcome. Conclusions There are significant sociodemographic inequalities in the rates of asthma-related hospital and ICU admissions. Treating atopic conditions in all age groups should be considered an integral part of asthma management. Adults have a wide range of potentially treatable risk factors that contribute substantially to asthma-related hospital admissions, including obesity, smoking, depression, anxiety and gastro-oesophageal reflux disease. Treating these risk factors could significantly reduce the rate of avoidable hospital admissions. Overall asthma medication burden is an important reflection of disease severity and prognostic marker of asthma outcomes, which should be monitored in all patients.

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“…Previous studies have found that female sex,9–12 previous exacerbations requiring hospital admission, 9 11 13 increased disease severity, 9 14 older age (≥45 years),9 11 12 younger age (<18), 10 15 ethnic minorities (African-American, Black and Indian),10 13 15 history of inhaled corticosteroids (ICS) (defined as ICS use in the preceding year),15 over-use of short-acting beta agonists16 and comorbidities such as chronic rhinitis and gastro-oesophageal reflux disease (GORD)11 are associated with asthma exacerbations including those requiring hospitalisation in children and adults. Previous studies also suggest that continued care and follow-up after hospitalisation reduce future asthma-related hospitalisations 17–19…”

Section: Introductionmentioning

confidence: 99%

Preventing unscheduled hospitalisations from asthma: a retrospective cohort study using routine primary and secondary care data in the UK (The PUSH-Asthma Study)—protocol paper

et al. 2022

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IntroductionAsthma is the most common chronic respiratory disease in children and adults. Asthma results in significant disease-related morbidity, healthcare costs and, in some cases, death. Despite efforts through implementation of national guidelines to improve asthma care, the UK has one of the highest asthma-related morbidity and mortality rates in the western world. New approaches are necessary to prevent asthma attacks in children and adults. The objectives of this study are to assess the association between demographic and clinical factors and asthma-related hospital admissions in children and adults, describe the epidemiology of asthma phenotypes among hospital attenders, and externally validate existing asthma risk prediction models.Methods and analysisThis is a retrospective cohort study of children and adults with asthma. Data will be extracted from the Clinical Practice Research Datalink (CPRD) Aurum database, which holds anonymised primary care data for over 13 million actively registered patients and covers approximately 19% of the UK population. The primary outcome will be asthma-related hospital admissions. The secondary outcomes will be prescriptions of short courses of oral corticosteroids (as a surrogate measure for asthma exacerbations), a composite outcome measure including hospital admissions and prescriptions of short courses of oral corticosteroids and delivery of asthma care management following hospital discharge. The primary analysis will use a Poisson regression model to assess the association between demographic and clinical risk factors and the primary and secondary outcomes. Latent class analysis will be used to identify distinct subgroups, which will further our knowledge on potential phenotypes of asthma among patients at high risk of asthma-related hospital admissions. A Concordance statistic (C-statistic) and logistic regression model will also be used to externally validate existing risk prediction models for asthma-related hospitalisations to allow for the optimal model to be identified and evaluated provide evidence for potential use of the optimal performing risk prediction model in primary care.Ethics and disseminationThis study was approved by the CPRD Independent Scientific Advisory Committee (reference number: 21_000512). Findings from this study will be published in a peer-reviewed journal and disseminated at national and international conferences.

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Factors associated with hospital admission in adult patients with asthma exacerbations: A systematic review

Cited by 10 publications

References 20 publications

Risk factors for hospitalization due to exacerbations among adult asthma patients in a district of Sri Lanka: a case‒control study.

Risk factors for hospitalization due to exacerbations among adult asthma patients in a district of Sri Lanka: a case‒control study.

Risk factors for asthma-related hospital and intensive care admissions in children, adolescents, and adults: a cohort study using primary and secondary care data

Preventing unscheduled hospitalisations from asthma: a retrospective cohort study using routine primary and secondary care data in the UK (The PUSH-Asthma Study)—protocol paper

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