Pan Jinqian, Xu Jie, Fedele David, Wu Yonghui, Brailsford Jennifer, Fishe Jennifer
Department of Health Outcomes and Biomedical Informatics, University of Florida College of Medicine, Gainesville, Florida, USA.
Nemours Center for Healthcare Delivery Science, Jacksonville, Florida, USA.
J Asthma. 2025 Jun 10:1-11. doi: 10.1080/02770903.2025.2514265.
Development of a feasible, accurate method to assess pediatric asthma severity would benefit clinical care and research. This study sought to determine pediatric asthma severity from retrospective electronic health record prescription data, and to compare severities before and after the 2020 National Asthma Education and Prevention Program (NAEPP) guideline update.
This retrospective analysis included patients ages 2 - 18 years of age from a large, multi-center healthcare provider. We assessed severity by mapping asthma-related medication prescriptions with NAEPP step-up therapy guidelines. We compared severities between the 2007 NAEPP guideline (2011-2020) and 2020 NAEPP guideline (2021-2023) periods.
We identified 55,818 pediatric asthma patients with a median age of 7.5 years. Overall, were either mild intermittent (41.6%) or mild persistent severity (34.9%), followed by 9.7% moderate persistent and 4.8% severe persistent severity. From the 2007 to 2020 NAEPP period, there was ∼5% decrease in mild persistent and moderate persistent severity, and a large increase in undefined severity from 7.0% to 19.6% after the 2020 NAEPP update.
This study's approach using outpatient medication prescription data to determine pediatric asthma severity according to NAEPP guidelines classified over 90% of patients. After the 2020 NAEPP guideline update, we found decreases in the proportion of children having mild and moderate persistent severity, and a large increase in patients for whom severity could not be determined due to off-label prescriptions. Mapping pediatric asthma severity through medication prescriptions is feasible, but further work is required to understand off-label prescribing patterns in pediatric asthma.
开发一种可行、准确的评估儿童哮喘严重程度的方法将有助于临床护理和研究。本研究旨在通过回顾性电子健康记录处方数据确定儿童哮喘严重程度，并比较2020年国家哮喘教育与预防计划（NAEPP）指南更新前后的严重程度。
这项回顾性分析纳入了来自一家大型多中心医疗服务机构的2至18岁患者。我们根据NAEPP逐步升级治疗指南对哮喘相关药物处方进行映射来评估严重程度。我们比较了2007年NAEPP指南（2011 - 2020年）和2020年NAEPP指南（2021 - 2023年）期间的严重程度。
我们确定了55818名儿童哮喘患者，中位年龄为7.5岁。总体而言，轻度间歇性（41.6%）或轻度持续性严重程度（34.9%）居多，其次是中度持续性（9.7%）和重度持续性严重程度（4.8%）。从2007年到2020年NAEPP期间，轻度持续性和中度持续性严重程度下降了约5%，2020年NAEPP更新后，未明确严重程度大幅增加，从7.0%增至19.6%。
本研究使用门诊药物处方数据根据NAEPP指南确定儿童哮喘严重程度的方法对超过90%的患者进行了分类。2020年NAEPP指南更新后，我们发现轻度和中度持续性严重程度的儿童比例下降，因超说明书用药处方导致严重程度无法确定的患者大幅增加。通过药物处方映射儿童哮喘严重程度是可行的，但需要进一步开展工作来了解儿童哮喘超说明书用药模式。
