Usher Institute, University of Edinburgh, United Kingdom.
Observational and Pragmatic Research Institute, Singapore, Singapore.
J Allergy Clin Immunol Pract. 2021 Apr;9(4):1612-1623.e9. doi: 10.1016/j.jaip.2020.11.053. Epub 2020 Dec 9.
Severe asthma may be underrecognized in primary care.
Identify and quantify patients with potential severe asthma (PSA) in UK primary care, the proportion not referred, and compare primary care patients with PSA with patients with confirmed severe asthma from UK tertiary care.
This was a historical cohort study including patients from the Optimum Patient Care Research Database (aged ≥16 years, active asthma diagnosis pre-2014) and UK patients in the International Severe Asthma Registry (UK-ISAR aged ≥18 years, confirmed severe asthma in tertiary care). In the OPCRD, PSA was defined as Global INitiative for Asthma 2018 step 4 treatment and 2 or more exacerbations/y or at Global INitiative for Asthma step 5. The proportion of these patients and their referral status in the last year were quantified. Demographic and clinical characteristics of groups were compared.
Of 207,557 Optimum Patient Care Research Database patients with asthma, 16,409 (8%) had PSA. Of these, 72% had no referral/specialist review in the past year. Referred patients with PSA tended to have greater prevalence of inhaled corticosteroid/long-acting β-agonist add-ons (54.1 vs 39.8%), and experienced significantly (P < .001) more exacerbations per year (median, 3 vs 2/y), worse asthma control, and worse lung function (% predicted postbronchodilator FEV/forced vital capacity, 0.69 vs 0.72) versus nonreferred patients. Confirmed patients with severe asthma (ie, UK patients in the International Severe Asthma Registry) were younger (51 vs 65 years; P < .001), and significantly (P < .001) more likely to have uncontrolled asthma (91.4% vs 62.5%), a higher exacerbation rate (4/y [initial assessment] vs 3/y), use inhaled corticosteroid/long-acting β-agonist add-ons (67.7% vs 54.1%), and have nasal polyposis (24.2% vs 6.8) than referred patients with PSA.
Large numbers of patients with PSA in the United Kingdom are underrecognized in primary care. These patients would benefit from a more systematic assessment in primary care and possible specialist referral.
严重哮喘在初级保健中可能未被充分识别。
确定和量化英国初级保健中具有潜在严重哮喘（PSA）的患者，未转诊的比例，并比较具有 PSA 的初级保健患者与来自英国三级保健的确诊严重哮喘患者。
这是一项历史队列研究，包括来自 Optimum Patient Care Research Database（年龄≥16 岁，2014 年前有哮喘活跃诊断）和 UK-ISAR 中的英国患者（国际严重哮喘注册研究中的 UK-ISAR，在三级保健中确诊为严重哮喘）。在 OPCRD 中，PSA 被定义为 2018 年全球哮喘倡议第 4 步治疗和每年 2 次或更多次加重/年或全球哮喘倡议第 5 步。量化了这些患者及其在过去一年中的转诊情况。比较了各组的人口统计学和临床特征。
在 Optimum Patient Care Research Database 中有哮喘的 207557 名患者中，有 16409 名（8%）患有 PSA。其中，72%的患者在过去一年中没有转诊/专家审查。具有 PSA 的转诊患者更倾向于使用吸入皮质激素/长效β激动剂附加药物（54.1%比 39.8%），并且每年经历的加重显著（P<.001）更多（中位数，每年 3 次比 2 次），哮喘控制更差，肺功能更差（支气管扩张后 FEV/用力肺活量的百分比预测值，0.69 比 0.72），而非转诊患者。确诊为严重哮喘的患者（即国际严重哮喘注册研究中的英国患者）年龄较小（51 岁比 65 岁；P<.001），且更可能患有未控制的哮喘（91.4%比 62.5%），加重率更高（每年 4 次[初始评估]比 3 次/年），使用吸入皮质激素/长效β激动剂附加药物（67.7%比 54.1%），以及患有鼻息肉（24.2%比 6.8%），比具有 PSA 的转诊患者更常见。
在英国，初级保健中严重哮喘的患者数量众多，但未被充分识别。这些患者将从初级保健中的更系统评估和可能的专家转诊中受益。
