Multinational cohort study of mortality in patients with asthma and severe asthma.
Adrenal Cortex Hormones
Age Factors
Asthma
/ mortality
Cause of Death
Cohort Studies
Comorbidity
Disease Progression
Drug Utilization
Emergency Service, Hospital
/ statistics & numerical data
Europe
/ epidemiology
Female
Hospitalization
/ statistics & numerical data
Humans
Male
Severity of Illness Index
Sex Factors
Smoking
/ adverse effects
Asthma epidemiology
Cohort studies
Mortality
Severe asthma
Journal
Respiratory medicine
ISSN: 1532-3064
Titre abrégé: Respir Med
Pays: England
ID NLM: 8908438
Informations de publication
Date de publication:
Historique:
received:
16
06
2019
revised:
24
02
2020
accepted:
26
02
2020
pubmed:
17
3
2020
medline:
14
1
2021
entrez:
17
3
2020
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 32174450
pii: S0954-6111(20)30059-7
doi: 10.1016/j.rmed.2020.105919
pii:
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
105919Informations de copyright
Copyright © 2020 Elsevier Ltd. All rights reserved.
Déclaration de conflit d'intérêts
Declaration of competing interest FA, SC, and EB are GSK employees and own stocks/shares in GSK. NB and RS were employees of GSK at the time this research was conducted and own stocks/shares in GSK. GP, CG, KB have no conflicts to declare. FL has received grants from Chiesi, GSK and Novartis. DPA has received research grants from Amgen, Bioiberica and GSK and speaker/advisory fees from Amgen and Bioiberica, paid to his department. KV has received grants from GSK and ZonMw. MR, PR, MS and KV's institution has received unconditional research grants from Boehringer-Ingelheim, Novartis, Pfizer, Yamanouchi, Servier, and Johnson & Johnson, unrelated to the current manuscript; MR, PR, MS and KV's received an unconditional grant from GSK to conduct research on incidence and risk factors of asthma exacerbations as part of the GSK/EU-ADR alliance. ES's institution (Aarhus University) has received a grant from the GSK/EU-ADR alliance related to this study. GB has received fees for lectures and/or advisory boards of AstraZeneca, Boehringer-Ingelheim, Chiesi, GSK, Novartis, Sanofi and Teva.