Work Environment Toxicology, The National Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
Department of Public Health and Caring Sciences, Family Medicine and Preventive Medicine, Uppsala University, Uppsala, Sweden.
Respir Res. 2018 Jan 18;19(1):12. doi: 10.1186/s12931-018-0719-x.
Severe and uncontrolled asthma is associated with increased risk of exacerbations and death. A substantial proportion of asthma patients have poor asthma control, and a concurrent COPD diagnosis often increases disease burden. The objective of the study was to describe the prevalence and managemant of severe asthma in a Swedish asthma popuöation.
In this observational cohort study, primary care medical records data (2006-2013) from 36 primary health care centers were linked to data from national mandatory Swedish health registries. The studied population (>18 years) had a record of drug collection for obstructive pulmonary disease (ATC code R03) during 2011-2012, and a physician diagnosed asthma (ICD-10 code J45-J46) prior to drug collection. Severe asthma was classified as collection of high dose inhaled steroid (> 800 budesonide or equivalent per day) and leukotriene receptor antagonist and/or long-acting beta-agonist. Poor asthma control was defined as either collection of ≥600 doses of short-acting beta-agonists, and/or ≥1 exacerbation(s) during the year post index date.
A total of 18,724 asthma patients (mean 49 years, 62.8% women) were included, of whom 17,934 (95.8%) had mild to moderate and 790 (4.2%) had severe asthma. Exacerbations were more prevalent in severe asthma (2.59 [2.41-2.79], Relative Risk [95% confidence interval]; p < 0.001). Poor asthma control was observed for 28.2% of the patients with mild to moderate asthma and for more than half (53.6%) of the patients with severe asthma (<0.001). Prior to index, one in five severe asthma patients had had a contact with secondary care and one third with primary care. A concurrent COPD diagnosis increased disease burden.
Severe asthma was found in 4.2% of asthma patients in Sweden, more than half of them had poor asthma control, and most patients had no regular health care contacts.
严重且不受控制的哮喘与哮喘恶化和死亡风险增加相关。相当一部分哮喘患者哮喘控制不佳，同时合并 COPD 诊断通常会增加疾病负担。本研究的目的是描述瑞典哮喘人群中严重哮喘的流行情况和管理情况。
在这项观察性队列研究中，我们对来自 36 个初级保健中心的初级保健医疗记录数据（2006-2013 年）进行了分析，并与来自瑞典国家强制性健康登记处的数据进行了关联。研究人群（>18 岁）在 2011-2012 年有记录显示使用了治疗阻塞性肺疾病的药物（ATC 代码 R03），并且在药物使用前有医生诊断为哮喘（ICD-10 代码 J45-J46）。严重哮喘被定义为吸入性皮质类固醇（>800 布地奈德或等效剂量/天）和白三烯受体拮抗剂和/或长效β-激动剂的高剂量使用。哮喘控制不佳定义为使用短效β-激动剂的剂量≥600 剂，或索引日期后一年内发生≥1 次哮喘恶化。
共纳入 18724 例哮喘患者（平均年龄 49 岁，62.8%为女性），其中 17934 例（95.8%）为轻中度哮喘，790 例（4.2%）为重度哮喘。严重哮喘患者的哮喘恶化更为常见（2.59 [2.41-2.79]，相对风险 [95%置信区间]；p<0.001）。轻中度哮喘患者中有 28.2%存在哮喘控制不佳，而重度哮喘患者中有超过一半（53.6%）存在哮喘控制不佳（p<0.001）。在索引日期之前，五分之一的重度哮喘患者曾接触过二级医疗，三分之一的患者曾接触过初级保健。同时合并 COPD 诊断会增加疾病负担。
在瑞典，4.2%的哮喘患者为重度哮喘，其中一半以上患者哮喘控制不佳，大多数患者没有定期的医疗保健接触。
