Marjolein Engelkes1, Maria Aj de Ridder1, Elisabeth Svensson2, Klara Berencsi2, Daniel Prieto-Alhambra3, Francesco Lapi4, Carlo Giaquinto5, Gino Picelli5, Nada Boudiaf6, Frank C Albers7, Sarah M Cockle8, Eric S Bradford9, Robert Y Suruki10, Guy Go Brusselle11, Peter R Rijnbeek1, Miriam Cjm Sturkenboom12, Katia Mc Verhamme13. 1. Medical Informatics, ErasmusMC, Rotterdam, the Netherlands. 2. Clinical Epidemiology, Aarhus, Denmark. 3. GREMPAL Research Group, Idiap Jordi Gol Primary Care Research Institute, Universitat Autonoma de Barcelona, Barcelona, Spain; Musculoskeletal Pharmaco and Device Epidemiology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, UK. 4. SIMG, Florence, Italy. 5. Pedianet, Padova, Italy. 6. Research and Development, GlaxoSmithKline, Middlesex, UK. 7. Global Respiratory Franchise, GlaxoSmithKline, Research Triangle Park, NC, United States. 8. Research and Development, GlaxoSmithKline, Brentford, UK. 9. Research and Development, GlaxoSmithKline, Research Triangle Park, NC, United States. 10. UCB Biosciences, Raleigh, NC, USA. 11. Department of Respiratory Medicine, Ghent University Hospital, Ghent, Belgium; Departments of Epidemiology and Respiratory Medicine, ErasmusMC, Rotterdam, the Netherlands. 12. Department of Epidemiology, Julius Center, Utrecht University, Utrecht, the Netherlands. 13. Medical Informatics, ErasmusMC, Rotterdam, the Netherlands. Electronic address: k.verhamme@erasmusmc.nl.
Abstract
BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma. METHODS:Asthmapatients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma. RESULTS: The cohort consisted of 586,436 asthmapatients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality. CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.
Authors: Angelica Tiotiu; Iulia Ioan; Nathalie Wirth; Rodrigo Romero-Fernandez; Francisco-Javier González-Barcala Journal: Int J Environ Res Public Health Date: 2021-01-23 Impact factor: 3.390
Authors: Elizabeth Benz; Sara R A Wijnant; Katerina Trajanoska; Johnmary T Arinze; Emmely W de Roos; Maria de Ridder; Ross Williams; Frank van Rooij; Katia M C Verhamme; M Arfan Ikram; Bruno H Stricker; Fernando Rivadeneira; Lies Lahousse; Guy G Brusselle Journal: ERJ Open Res Date: 2022-01-10