Caminati Marco, Vianello Andrea, Ricci Giorgio, Festi Giuliana, Bellamoli Roberto, Longhi Sofia, Crivellaro Mariangiola, Marcer Guido, Monai Marco, Andretta Margherita, Bovo Chiara, Senna Gianenrico
Asthma Center and Allergy Unit, Verona University and General Hospital, Verona, Italy.
Department of Medicine, University of Verona, Verona, Italy.
World Allergy Organ J. 2019 Jul 3;12(7):100046. doi: 10.1016/j.waojou.2019.100046. eCollection 2019.
Asthma still represents a cause of death and hospital admissions worldwide. Our study aimed at analyzing the trend of Emergency Room (ER) asthma admissions in Northeast Italy in order to investigate the relevance of specific patient-related determinants and environmental triggers (pollens, mold spores, and pollutants).
Retrospective data from admissions for asthma exacerbations registered between the years 2013 and 2015 in two main ERs in Northeast Italy were collected. Data about patients' age, sex and nationality were recorded. Classification of disease severity followed the current Italian ER triage scoring system (white: no need for emergency treatment; green: need for fast treatment; yellow: severe condition; red: life-threatening condition). Data on pollen/mold spore counts and pollutants were analyzed.
Overall, 1745 ER admissions for asthma were registered, with a persistent and significant increase year by year. A slight prevalence of females and patients over 50 years old was observed. Immigrants accounted for 32%, 36% and 26% of admissions respectively in 2013, 2014 and 2015. The prevalence of immigrants' admissions was significantly higher when comparing the relative ratio of immigrant populations/Italian nationals (p < 0.05). The admissions were coded as follows: white, 6.30%; green, 35.36%; yellow, 39.37%; red, 18.97%. People aged ≥50 years were more frequently admitted with a red code, but the trend was not statistically significant (p = 0,0815). By contrast, amongst immigrants there was a higher prevalence of white and green codes observed in comparison with Italian nationals. Grass pollen peak and PM high levels represented environmental determinants of ER admissions increase.
The increasing rate of asthma-related ER admissions highlights the need for implementing asthma control strategies. Investigating the traits of patients referring to ER for asthma exacerbations, as well as environmental-related determinants, may help in identifying at-risk individuals and in orienting preventive strategies accordingly. Immigrants represent the most vulnerable sub-population, and their potential difficulties in accessing treatments and health services should be specifically addressed. Overall, implementing patient education in order to improve treatment adherence, as well as providing an asthma action plan to every asthmatic patient, continue to be the most urgent needs.
哮喘仍是全球范围内导致死亡和住院的原因之一。我们的研究旨在分析意大利东北部急诊室（ER）哮喘住院的趋势，以调查特定患者相关决定因素和环境触发因素（花粉、霉菌孢子和污染物）的相关性。
收集了2013年至2015年期间意大利东北部两个主要急诊室登记的哮喘加重住院的回顾性数据。记录了患者的年龄、性别和国籍。疾病严重程度分类遵循当前意大利急诊室分诊评分系统（白色：无需紧急治疗；绿色：需要快速治疗；黄色：严重状况；红色：危及生命状况）。分析了花粉/霉菌孢子计数和污染物的数据。
总体而言，共登记了1745例急诊室哮喘住院病例，且逐年持续显著增加。观察到女性和50岁以上患者略有占比优势。移民在2013年、2014年和2015年的住院病例中分别占32%、36%和26%。比较移民人口/意大利国民的相对比例时，移民住院的患病率显著更高（p < 0.05）。住院病例编码如下：白色，6.30%；绿色，35.36%；黄色，39.37%；红色，18.97%。≥50岁的人更常以红色编码住院，但该趋势无统计学意义（p = 0.0815）。相比之下，与意大利国民相比，移民中白色和绿色编码的患病率更高。草花粉峰值和高浓度颗粒物是急诊室住院病例增加的环境决定因素。
与哮喘相关的急诊室住院率上升凸显了实施哮喘控制策略的必要性。调查因哮喘加重而前往急诊室的患者特征以及与环境相关的决定因素，可能有助于识别高危个体并据此制定预防策略。移民是最脆弱的亚人群体，应特别关注他们在获得治疗和医疗服务方面可能遇到的困难。总体而言，开展患者教育以提高治疗依从性，以及为每位哮喘患者提供哮喘行动计划，仍然是最迫切的需求。
