Exacerbation Patterns in Adults with Asthma in England A Population-based Study
Exacerbation Patterns in Adults with Asthma in England A Population-based Study
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DOI：
10.1164/rccm.201808-1516oc
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发表时间：
2019-02-15
影响因子：
24.7
通讯作者：
Cullinan, Paul
中科院分区：
文献类型：
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作者：
Bloom, Chloe I.;Palmer, Thomas;Cullinan, Paul
理论基础：哮喘是异质性的，对恶化模式缺乏了解。目的：在一个包含所有疾病严重程度的人群中描述长期随访中的恶化模式。方法：我们使用电子医疗记录来识别年龄在18-55岁的哮喘患者及其在2007-2015年间的恶化。一组数据大于或等于7年的队列被用来描述由药物使用定义的哮喘严重程度的恶化模式。使用Logistic回归分析，计算风险因素对零星(单年恶化)和复发性(1年)恶化模式的影响估计。在嵌套病例对照设计中，研究了跨越5年的恶化病史与未来恶化之间的关系。测量和主要结果：共有51,462名患者符合7年队列研究的条件；%的患者没有恶化。在加重的患者中，51%只恶化一次；病情加重的频率随着疾病严重程度的增加而增加。只有370名患者(0.7%)具有频繁发作表型(每年发作)的特征，其中58%患有轻度/中度哮喘。恶化风险因素与特定的恶化模式不是唯一相关的。与所有其他因素相比，过去的恶化增加了未来恶化的风险，尽管这种影响在5年后消失。结论：在7年的随访中，大约三分之一的患者发生了恶化。在那些加重的人中，有一半不会再次恶化；未来恶化的时间在很大程度上是不可预测的。只有2%的人表现出频繁加重的表型。过去的恶化模式是预测未来恶化的最具信息量的风险因素。
Rationale: Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease.Objectives: To describe exacerbation patterns over a prolonged follow-up in a population that includes patients of all disease severity.Methods: We used electronic health care records to identify patients with asthma aged 18-55 years and their exacerbations from 2007 to 2015. A cohort with greater than or equal to 7 years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 yr) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5 years, and a future exacerbation was examined.Measurements and Main Results: A total of 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterized by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5 years.Conclusions: During 7 years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.