Département de Pneumologie et Addictologie, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France; PhyMedExp, University of Montpellier, INSERM U1046, CNRS UMR 9214, Hôpital Arnaud de Villeneuve, CHU de Montpellier, Montpellier, France.
AstraZeneca, Courbevoie, France.
J Allergy Clin Immunol Pract. 2019 May-Jun;7(5):1477-1487. doi: 10.1016/j.jaip.2018.12.029. Epub 2019 Jan 25.
Severe asthma (SA) is defined by treatment intensity. The availability of national databases allows accurate estimation of the prevalence, long-term outcomes, and costs of SA.
To provide accurate information on SA, focusing on comorbidities, mortality, health care resource consumption, and associated costs.
A cohort of patients with SA identified in 2012 was extracted from a French representative claims database and followed for 3 years. Their characteristics, comorbidities, mortality, and direct costs were compared with a matched control group without asthma.
A total of 690 patients with SA were matched to 2070 patients without asthma (mean age, 61 years; 65.7% women). The prevalence of SA was estimated to be 0.18% to 0.51% of the French adult population. Comorbidities were more frequent in patients with SA (73.9% suffered from cardiovascular disease vs 54.3% in controls; P < .001). A total of 58.7% of patients with SA used oral corticosteroids (OCS) in 2012 with a mean intake of 3.3 boxes/year/patient and 9% received ≥6 dispensings of OCS. A total of 6.7% were treated by omalizumab. Patients with SA were more frequently hospitalized (33.2% vs 19.7%; P < .001), more frequently consulted a general practitioner (97.8% vs 83.9%; P < .001) (9.8 ± 6.8 vs 6.2 ± 5.3 consultations/year; P < .001), and 31% have consulted a private respiratory physician. Compared with controls, 3-year cumulative mortality was higher in SA (7.1% vs 4.5%; P = .007). Direct medical cost was $9227 versus $3950 (P < .001) mostly driven by medication costs.
The prevalence of SA in the French adult population is at least 18 of 10,000. Burden of disease is high with respect to comorbidities, mortality, and asthma-related health care resource use.
重度哮喘（SA）是根据治疗强度来定义的。国家数据库的可用性使得对 SA 的患病率、长期结局和成本的准确估计成为可能。
提供关于 SA 的准确信息，重点关注合并症、死亡率、医疗资源消耗和相关成本。
从法国具有代表性的索赔数据库中提取了 2012 年确诊的 SA 患者队列，并对其进行了 3 年的随访。将他们的特征、合并症、死亡率和直接成本与没有哮喘的匹配对照组进行比较。
共有 690 名 SA 患者与 2070 名没有哮喘的患者相匹配（平均年龄 61 岁；65.7%为女性）。SA 的患病率估计为法国成年人口的 0.18%至 0.51%。SA 患者的合并症更为常见（73.9%患有心血管疾病，而对照组为 54.3%；P<0.001）。2012 年，共有 58.7%的 SA 患者使用口服皮质类固醇（OCS），平均每年每名患者使用 3.3 盒，9%的患者接受了≥6 次 OCS 配药。共有 6.7%的患者接受了奥马珠单抗治疗。SA 患者住院治疗的比例更高（33.2%比 19.7%；P<0.001），更频繁地就诊于全科医生（97.8%比 83.9%；P<0.001）（9.8±6.8 次/年比 6.2±5.3 次/年；P<0.001），31%的患者就诊于私人呼吸科医生。与对照组相比，SA 患者的 3 年累积死亡率更高（7.1%比 4.5%；P=0.007）。直接医疗费用为 9227 美元，而对照组为 3950 美元（P<0.001），主要由药物费用驱动。
法国成年人群中 SA 的患病率至少为每 10000 人中有 18 人。疾病负担高，与合并症、死亡率和与哮喘相关的医疗资源使用有关。
