Performance of database-derived severe exacerbations and asthma control measures in asthma: responsiveness and predictive utility in a UK primary care database with linked questionnaire data

Abstract

BackgroundObservational research is essential to evaluate the real-life effectiveness of asthma treatments and can now make use of outcomes derived from electronic medical records.AimThe aim of this study was to investigate the utility of several database outcome measures in asthma.MethodsThis study identified cohorts of patients with active asthma from a UK primary care database – Optimum Patient Care Research Database – approximately 10% of which was prospectively supplemented with questionnaire data. The “Questionnaire cohort” included patients aged 18–60 years with valid questionnaire data and 1 year of continuous primary care data. Separate “ICS initiation” and “ICS step-up” cohorts included patients aged 5–60 years initiated on inhaled corticosteroids (ICSs), who had 1 year of continuous primary care data before, and after, this index visit. Database measures of asthma symptom control and exacerbations were identified in the Optimum Patient Care Research Database and cross-tabulated with corresponding patient-reported (questionnaire) data. Responsiveness of the database outcomes was analyzed, using McNemar’s and Wilcoxon’s signed rank tests, and Poisson regression was used to estimate the association between database outcomes and future risk of database exacerbations, in the ICS initiation cohort.ResultsThe final study included 2,366 Questionnaire cohort patients and 51,404 ICS initiation patients. Agreement between patient-reported and database-recorded exacerbations was fair (kappa 0.35). Following the initiation of ICS, database risk domain asthma control (based on exacerbations) improved (proportion of patients with uncontrolled asthma decreased from 24.9% to 18.6%; P<0.001) and mean number of database exacerbations decreased from 0.09 to 0.08 per patient per year (P=0.001). However, another measure of asthma control which includes short-acting beta-agonist prescription as part of the definition did not show this improvement. Patients with prior exacerbations had a higher risk of future exacerbation (rate ratio [95% confidence interval], 3.23 [3.03–3.57]).ConclusionAsthma control and exacerbations derived from primary care databases were responsive, with the exception of short-acting beta-agonist prescriptions, and useful for risk prediction.

The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach

“…14 For a patient to be controlled corresponding to this definition of RDAC, they had to have no evidence of moderate to severe asthma exacerbations (ie, no asthma-related hospitalizations or emergency visits or OCS prescriptions) in their follow-up records and no evidence of asthma-related antibiotic prescriptions or outpatient attendances. 14 RDAC is thus Vervloet, M., Dijk, L. van, Spreeuwenberg, P., Price, D., Chrisholm, A., Ganse, E. van, Pinnock, H., Rand, C.S., Eakin, Michelle N., Schermer, T., Souverein, P.C., Dima, A.L. The relationship between real-world inhaled corticosteroids adherence and asthma outcomes: a multilevel approach.…”

Real‐life effectiveness of inhaler device switch from dry powder inhalers to pressurized metred‐dose inhalers in patients with asthma treated with ICS/LABA

“…Severe exacerbation was defined based on the American Thoracic Society/European Respiratory Society (ATS/ERS) Task Force 2015 definition 14 : any asthmarelated hospitalization or emergency hospital attendance or prescription of acute course of OCS. Other respiratory-related outcomes investigated included previously validated 15 database measures of asthma control: risk domain asthma control (RDAC) and overall asthma control (OAC), as described and defined in Table 1.…”

Evaluating the real-life effect of MP-AzeFlu on asthma outcomes in patients with allergic rhinitis and asthma in UK primary care

“…32 Asthma-related outcome measures within the OPCRD have been validated using patient reported outcomes. 35 …”

“…This definition has previously been validated as part of the Risk Domain Asthma Control questionnaire. 35 An occurrence of any of these factors within 14 days of each other was considered to belong to the same event ( Table 1 ). The secondary outcome was change in the number of asthma exacerbations.…”