Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort.
Burden and unmet need for specialist care in poorly controlled and severe childhood asthma in a Danish nationwide cohort.
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DOI：
10.1186/s12931-023-02482-7
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发表时间：
2023-06-27
影响因子：
5.8
通讯作者：
Rastogi, Deepa
中科院分区：
文献类型：
--
作者：
Hakansson, Kjell Erik Julius;Guerrero, Silvia Cabrera;Backer, Vibeke;Ulrik, Charlotte Suppli;Rastogi, Deepa
哮喘是儿童和青少年时期的常见疾病，具有终身后果，特别是在那些有严重疾病风险、控制不良和/或频繁加重的人群中。专家护理建议为高危儿童和青少年，但在免费获得医疗保健机构获得专家管理仍然知之甚少。对丹麦全国2-17岁持续性哮喘儿童和青少年队列（定义为2015年期间反复使用吸入性皮质类固醇（ICS））进行了为期两年的随访，以确定包括重度哮喘患者在内的高危儿童和青少年（根据GINA 2020指南分类），控制不良（定义为使用400/600（2-11/12 +）年剂量的短效支气管扩张剂）或频繁加重（定义为使用口服类固醇或住院治疗），并获得专科护理。在全民保健的背景下，选择人口是因为有详细的医疗记录。该队列包括29，851名儿童和青少年（59%为男孩），中位年龄为9岁。虽然17%的儿童接受高剂量ICS，但22%的儿童每天接受低于GINA低剂量临界值的ICS。严重哮喘的患病率（3.0-6.5%）低于哮喘控制不良（6.4-25%）;两者均从儿童期到青春期下降。7.1-9.0%的儿童发生急性加重，中位急性加重次数为1次（IQR 1-1）。尽管被归类为轻度至中度哮喘，但分别有15%的哮喘控制不良和3.8%的哮喘发作。虽然61%的严重哮喘儿童和58%的易加重疾病儿童接受专科护理，但只有24%的疾病不受控制的儿童接受专科护理。在使用高剂量ICS的儿童和青少年中，71%在初级保健中得到管理，而使用额外的控制剂在专科护理中更常见。在整个儿童和青少年时期，严重哮喘和控制不良的患病率很高，尽管其患病率随着年龄的增长而下降。我们证明，即使在一个免费获得，税收资助的医疗保健系统中，哮喘高危儿童，特别是哮喘控制不良的儿童，对专家护理的需求也很大。在线版本包含补充材料，可通过10.1186/s12931-023-02482-7获取。
Asthma is a common disease in childhood and adolescence with lifelong consequences particularly among those at risk of severe disease, poor control and/or frequent exacerbations. Specialist care is recommended for at-risk children and adolescents, yet access to specialist management in free-to-access healthcare settings remains poorly understood. A Danish nationwide cohort of children and adolescents aged 2–17 years with persistent asthma, defined as repeated redemption of inhaled corticosteroids (ICS) during 2015, were followed for two years, to identify at-risk children and adolescents comprising those with severe asthma (classified according to GINA 2020 guidelines), poor control (defined as use of 400/600 (ages 2–11/12 +) annual doses of short-acting bronchodilators), or frequent exacerbations (defined as use of oral steroids or hospitalization), and access to specialist care. The population is chosen due to detailed medical records in the setting of universal health care. The cohort comprised of 29,851 children and adolescents (59% boys), with a median age of 9 years. While 17% of children were on high dose ICS, 22% were on daily ICS below GINA low dose cut-off. Prevalence of severe asthma (3.0–6.5%) was lower than poor asthma control (6.4–25%); both declined from childhood to adolescence. Exacerbations occurred in 7.1–9.0% of children, with median number of exacerbations being 1 (IQR 1–1). Despite being classified as having mild-to-moderate asthma, 15% had poor asthma control and 3.8% experienced exacerbation(s), respectively. While 61% of children with severe asthma and 58% with exacerbation-prone disease were in specialist care, only 24% with uncontrolled disease were receiving specialist care. Of children and adolescents using high-dose ICS, 71% were managed in primary care, while the use of additional controllers was more common in specialist care. Throughout childhood and adolescence, there was a high prevalence of severe asthma and poor control, although their prevalence declined with age. We demonstrate a large unmet need for specialist care among children with at-risk asthma, particularly among those with poorly controlled asthma, even in a system with free-to-access, tax-funded healthcare. The online version contains supplementary material available at 10.1186/s12931-023-02482-7.
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DOI：
10.1016/j.jaip.2021.05.003
发表时间：
2021-10-06
影响因子：
9.4
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