Exacerbation risk and characterisation of the UK's asthma population from infants to old age

• Published in: Thorax Vol. 73; no. 4; p. 313
• Main Authors: Bloom, Chloe I, Nissen, Francis, Douglas, Ian J, Smeeth, Liam, Cullinan, Paul, Quint, Jennifer K
• Format: Journal Article
• Language: English
• Published: England 01-04-2018
• Subjects: Adolescent; Adult; Aged; Asthma - diagnosis; Asthma - drug therapy; Asthma - epidemiology; Asthma - mortality; Body Mass Index; Child; Child, Preschool; Cohort Studies; Female; Follow-Up Studies; Humans; Infant; Kaplan-Meier Estimate; Male; Middle Aged; Prevalence; Retrospective Studies; Risk Factors; Severity of Illness Index; United Kingdom - epidemiology; United Kingdom; asthma; asthma epidemiology
• ISSN: 1468-3296
• DOI: 10.1136/thoraxjnl-2017-210650

Few studies have examined the characteristics of a general asthma population; most have focused on more severe patients or severe exacerbations.
This population-based cohort study, from April 2007 to September 2015, used linked primary and secondary care electronic healthcare records (Clinical Practice Research Datalink, Hospital Episode Statistics). Characteristics of four age cohorts, 'Under 5s', '5 to 17s', '18 to 54s', '55+', were described. Exacerbation risk factors, including asthma severity (measured by the British Thoracic Society (BTS) stepwise approach), were assessed using Poisson regression.
424 326 patients with current asthma were eligible (n, median follow-up: 'Under 5s'=17 320, 1 year; '5 to 17s'=82 707, 3.3 years; '18 to 54s'=210 724, 4 years; '55+'=113 575, 5.1 years). Over 60% of the total study population had mild asthma (BTS steps 1/2). There were differences between the cohort's characteristics, including by gender, disease severity and exacerbation pattern. The rate of exacerbations was highest in the oldest cohort and lowest in the '5 to 17s' cohort (rate per 10 person-years (95% CI), 'Under 5s'=4.27 (4.18 to 4.38), '5 to 17s'=1.48 (1.47 to 1.50), '18 to 54s'=3.22 (3.21 to 3.24), '55+'=9.40 (9.37 to 9.42)). In all cohorts, exacerbation rates increased with increasing asthma severity, after adjusting for confounders including gender, socioeconomic status, smoking, body mass index, atopy, rhinitis, gastro-oesophageal reflux, anxiety, depression and COPD.
The majority of UK patients with asthma had mild asthma and did not experience an exacerbation during follow-up. Patients aged ≥55 years had the lowest proportion with mild asthma and highest rate of exacerbations; the opposite was found in patients aged between 5 and 18 years.