Title: Assessment of Asthma Exacerbations in a Real-World Setting over 4 Years
Abstract: RATIONALE: The objective of this study was to describe exacerbation trends in a managed care setting.METHODS: An administrative claims database containing 8.8 million lives was analyzed for 4 years (June 2000 - May 2004). Patients aged ≥12 years with an asthma diagnosis and ≥2 claims/year for asthma medication were included; those with COPD and other significant respiratory conditions were excluded. Exacerbations were defined by asthma-related emergency department (ED) visits, asthma-related hospitalizations, or asthma-related oral corticosteroid (OCS) bursts. Exacerbation rates (over years 2-4) of patients who had an exacerbation during year 1 were compared with patients who were exacerbation-free in year 1.RESULTS: A total of 3,998 patients (mean age=41 years, 65% female) met all study inclusion/exclusion criteria. During the study period, 42% of patients had an asthma exacerbation (65% OCS use, 16% ED visits, and 19% hospitalizations), with 26% of patients having an exacerbation in only 1 of the 4 years, 11% in 2/4 years, 4% in 3/4 years, and 1% in all 4 years. Patients who had an exacerbation in year 1 were about twice as likely to have another exacerbation in years 2-4 vs patients who were exacerbation-free in year 1 (58% vs. 30%; P<0.001). Exacerbation rates/year were essentially stable over the 4-year period (year 1 = 17.5%, year 2 = 16.9%, year 3 = 15.2%, year 4 = 16.0%).CONCLUSIONS: Although previous exacerbations can predict future exacerbations, patients having exacerbations every year are rare. During the 4-year study period, exacerbation rates did not decline substantially. RATIONALE: The objective of this study was to describe exacerbation trends in a managed care setting. METHODS: An administrative claims database containing 8.8 million lives was analyzed for 4 years (June 2000 - May 2004). Patients aged ≥12 years with an asthma diagnosis and ≥2 claims/year for asthma medication were included; those with COPD and other significant respiratory conditions were excluded. Exacerbations were defined by asthma-related emergency department (ED) visits, asthma-related hospitalizations, or asthma-related oral corticosteroid (OCS) bursts. Exacerbation rates (over years 2-4) of patients who had an exacerbation during year 1 were compared with patients who were exacerbation-free in year 1. RESULTS: A total of 3,998 patients (mean age=41 years, 65% female) met all study inclusion/exclusion criteria. During the study period, 42% of patients had an asthma exacerbation (65% OCS use, 16% ED visits, and 19% hospitalizations), with 26% of patients having an exacerbation in only 1 of the 4 years, 11% in 2/4 years, 4% in 3/4 years, and 1% in all 4 years. Patients who had an exacerbation in year 1 were about twice as likely to have another exacerbation in years 2-4 vs patients who were exacerbation-free in year 1 (58% vs. 30%; P<0.001). Exacerbation rates/year were essentially stable over the 4-year period (year 1 = 17.5%, year 2 = 16.9%, year 3 = 15.2%, year 4 = 16.0%). CONCLUSIONS: Although previous exacerbations can predict future exacerbations, patients having exacerbations every year are rare. During the 4-year study period, exacerbation rates did not decline substantially.