Department of Respiratory and Critical Care Medicine, Changi General Hospital, Singapore.
Ann Acad Med Singap. 2017 Jun;46(6):217-228.
Understanding the burden of uncontrolled severe asthma is essential for disease-targeted healthcare planning. There is a scarcity of data regarding the proportion, healthcare utilisation and costs of patients with uncontrolled severe asthma in Asia. This study aimed to plug the knowledge gap in this area.
Consecutive patients with asthma managed in our respiratory specialist clinic were evaluated prospectively. Healthcare utilisation comprising unscheduled asthma-related primary care visits, emergency department (ED) visits and hospital admissions were obtained from the national health records system. We defined uncontrolled severe asthma as poor symptom control (Asthma Control Test score <20); 2 or more asthma exacerbations requiring ≥3 days of systemic corticosteroids in the previous year; 1 or more serious asthma exacerbation requiring hospitalisation in the previous year; or airflow limitation with pre-bronchodilator forced expiratory volume in 1 second (FEV) <80% predicted despite high dose inhaled corticosteroids and another controller medication.
Of the 423 study participants, 49 (11.6%) had uncontrolled severe asthma. Compared to non-severe asthma, patients with uncontrolled severe asthma were older and more likely to be female and obese. They had a median of 2 (interquartile range: 0 to 3) exacerbations a year, with 51% having ≥2 exacerbations in the past 12 months. They were responsible for 43.9% of the hospital admissions experienced by the whole study cohort. Mean annual direct asthma costs per patient was S$2952 ± S$4225 in uncontrolled severe asthma vs S$841 ± S$815 in non-severe asthma.
Approximately 12% of patients with asthma managed in a hospital-based respiratory specialist clinic in Singapore have uncontrolled severe asthma. They account for a disproportionate amount of healthcare utilisation and costs. Healthcare strategies targeting these patients are urgently needed.
了解未控制的重度哮喘的负担对于有针对性的医疗保健规划至关重要。亚洲地区关于未控制的重度哮喘患者的比例、医疗保健利用情况和费用的数据稀缺。本研究旨在填补这一领域的知识空白。
连续评估在我们呼吸专科诊所接受管理的哮喘患者。通过国家卫生记录系统获得医疗保健利用情况，包括非计划性哮喘相关初级保健就诊、急诊就诊和住院治疗。我们将未控制的重度哮喘定义为：症状控制不佳（哮喘控制测试评分<20）；过去一年中需要≥3 天全身皮质类固醇治疗的 2 次或以上哮喘加重；过去一年中需要住院治疗的 1 次或以上严重哮喘加重；或在使用高剂量吸入皮质类固醇和另一种控制药物后，支气管扩张剂前一秒用力呼气量（FEV）<80%预测值的气流受限。
在 423 名研究参与者中，有 49 名（11.6%）患有未控制的重度哮喘。与非重度哮喘相比，患有未控制的重度哮喘的患者年龄更大，且更可能为女性和肥胖。他们每年的平均发作次数为 2 次（中位数：0 至 3 次），过去 12 个月中有 51%的患者发作次数≥2 次。他们占整个研究队列住院人数的 43.9%。未控制的重度哮喘患者每人每年的直接哮喘费用为 2952 新元（±4225 新元），而非重度哮喘患者为 841 新元（±815 新元）。
在新加坡一家医院呼吸专科诊所管理的哮喘患者中，约有 12%患有未控制的重度哮喘。他们占医疗保健利用情况和费用的不成比例的比例。迫切需要针对这些患者的医疗保健策略。
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