Department of Medicine, University of Arizona, Tucson, Ariz.
Inovalon, Bowie, Md.
J Allergy Clin Immunol Pract. 2024 Jul;12(7):1775-1782.e2. doi: 10.1016/j.jaip.2024.03.018. Epub 2024 Mar 18.
Understanding the implementation of key guideline recommendations is critical for managing severe asthma (SA) in the treatment of uncontrolled disease.
To assess specialist visits and medication escalation in US patients with SA after events indicating uncontrolled disease (EUD) and associations with health outcomes and social disparity indicators.
Patients with SA appearing in administrative claims data spanning 2015 to 2020 were indexed hierarchically on asthma-related EUD, including hospitalizations, emergency department visits with systemic corticosteroid treatment, or outpatient visits with systemic corticosteroid treatment. Patients with SA without EUD served as controls. Eligibility included age 12 or greater, 12 months enrollment before and after index, no biologic use, and no other major respiratory disease during the pre-period. Escalation of care in the form of specialist visits and medication escalation, health care resource use, costs, and disease exacerbations were assessed during follow-up.
We identified 180,736 patients with SA (90,368 uncontrolled and 90,368 controls). Between 35% and 51% of patients with SA with an EUD had no specialist visit or medication escalation. Follow-up exacerbations ranged from 51% to 4% across EUD cohorts, compared with 13% in controls. Among uncontrolled patients with SA who were Black or Hispanic/Latino, 41% and 38%, respectively, had no specialist visit or medication escalation after EUD, compared with 33% of non-Hispanic White patients.
A substantial proportion of uncontrolled patients with SA had no evidence of specialist visits or medication escalation after uncontrolled disease, and there was a clear relationship between uncontrolled disease and subsequent health care resource use and exacerbations. Findings highlight the need for improved guideline-based care delivery to patients with SA, particularly for those facing social disparities.
了解关键指南建议的实施对于管理治疗控制不佳的严重哮喘（SA）至关重要。
评估美国 SA 患者在出现表明疾病控制不佳（EUD）的事件后专家就诊和药物升级情况，以及与健康结果和社会差异指标的关联。
在 2015 年至 2020 年期间的行政索赔数据中，根据与哮喘相关的 EUD 对出现 SA 的患者进行分层索引，包括住院、接受全身皮质类固醇治疗的急诊就诊或接受全身皮质类固醇治疗的门诊就诊。未出现 EUD 的 SA 患者作为对照。入选标准包括年龄 12 岁或以上、索引前和索引后 12 个月入组、未使用生物制剂和在前期间无其他主要呼吸道疾病。在随访期间评估了专家就诊和药物升级、医疗保健资源使用、成本和疾病恶化的形式的护理升级。
我们确定了 180736 例 SA 患者（90368 例控制不佳和 90368 例对照）。出现 EUD 的 SA 患者中，有 35%至 51%没有专家就诊或药物升级。在 EUD 队列中，随访期间的恶化率从 51%到 4%不等，而对照组为 13%。在出现 EUD 的 SA 控制不佳的黑人或西班牙裔/拉丁裔患者中，分别有 41%和 38%没有专家就诊或药物升级，而非西班牙裔白人患者中这一比例为 33%。
相当一部分控制不佳的 SA 患者在出现控制不佳的疾病后没有接受专家就诊或药物升级的证据，而且控制不佳的疾病与随后的医疗保健资源使用和恶化之间存在明显关系。这些发现强调了需要改善针对 SA 患者的基于指南的护理提供，特别是对于面临社会差异的患者。
