Retrospective Review on Patients With Recurrent Asthmatic Attacks Requiring Hospitalizations
NCT ID: NCT04479501
Last Updated: 2020-07-21
Study Results
Results pending
The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.
Basic Information
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Recruitment Status
COMPLETED
Total Enrollment
2280 participants
Study Classification
OBSERVATIONAL
Study Start Date
2017-12-01
Study Completion Date
2019-12-31
Brief Summary
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Asthma is a common respiratory disease. around the world. Asthma exacerbation is one of the major sequelae and associated with various morbidity and mortality. A satisfactory asthma control can help to bring down the risk of exacerbation and hence hospitalization. However, the real-world evidence on the clinical factors that leads to multiple admissions, when compared with single admission, due to asthma exacerbation is scarce. This study aimed at evaluating the clinical characteristics of patients who had single and multiple hospitalizations for asthma exacerbations, and exploring the risk factors that predict multiple hospitalizations.
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Detailed Description
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Asthma is a common respiratory disease worldwide and in Hong Kong. According to the estimation by the Center for Disease Control and Prevention in 2015, 7.6% adults in the United States have asthma. In Hong Kong, the prevalence of asthma was estimated to be 10.1% among 13 to 14 years old children and 5.8% in randomly selected Chinese elderly aged more than 70. The clinical characteristics varies in different age groups, with elderly asthmatics have higher rates of bronchial hyper-reactivity and more severe phenotypes, when comparing with younger patients. This is more important in an ageing population.
Asthmatic exacerbation is not an uncommon complication and can be fatal. For those patients with near-fatal asthma exacerbation, ICU admission and mechanical ventilation may be necessary to prevent mortality. This is more common among poor controllers and adults. Asthma-related deaths may be reduced if risk factors are recognized and addressed early.
Many predictors for exacerbation had been identified, both endogenous and exogenous, including high eosinophil count, upper airway diseases, gastroesophageal reflux, poor inhaler technique, medication non-compliance, guideline non-compliance. One of the most powerful predictors for future exacerbation in patients with severe or difficult-to-treat asthma is a recent severe asthma exacerbation. In addition, hospitalization for exacerbations requiring ICU care and mechanical ventilation are both predictors for near-fatal asthma. After the acute attack, its unfavourable impact continues and can lead to multiple sequelae. Exacerbation of asthma is associated with a more rapid decline in the post-bronchodilator forced expiratory volume in 1 second and worse quality of life. In addition, individuals with uncontrolled asthma had higher medical expenditures and decreased productivity, contributing to a greater economic burden when compared with individuals without asthma. In contrary, patients with controlled asthma had lower hospitalization rate, mortality rate and less decline in lung function.
Many of these factors are potentially reversible. But, there is still a significant proportion of asthma patients experiencing recurrent exacerbation despite optimization of pharmacological treatment. A model of better asthma care may be established by improving the understanding on these risk factors, leading to less exacerbation events.
Asthmatic exacerbation is not an uncommon complication and can be fatal. For those patients with near-fatal asthma exacerbation, ICU admission and mechanical ventilation may be necessary to prevent mortality. This is more common among poor controllers and adults. Asthma-related deaths may be reduced if risk factors are recognized and addressed early.
Many predictors for exacerbation had been identified, both endogenous and exogenous, including high eosinophil count, upper airway diseases, gastroesophageal reflux, poor inhaler technique, medication non-compliance, guideline non-compliance. One of the most powerful predictors for future exacerbation in patients with severe or difficult-to-treat asthma is a recent severe asthma exacerbation. In addition, hospitalization for exacerbations requiring ICU care and mechanical ventilation are both predictors for near-fatal asthma. After the acute attack, its unfavourable impact continues and can lead to multiple sequelae. Exacerbation of asthma is associated with a more rapid decline in the post-bronchodilator forced expiratory volume in 1 second and worse quality of life. In addition, individuals with uncontrolled asthma had higher medical expenditures and decreased productivity, contributing to a greater economic burden when compared with individuals without asthma. In contrary, patients with controlled asthma had lower hospitalization rate, mortality rate and less decline in lung function.
Many of these factors are potentially reversible. But, there is still a significant proportion of asthma patients experiencing recurrent exacerbation despite optimization of pharmacological treatment. A model of better asthma care may be established by improving the understanding on these risk factors, leading to less exacerbation events.
Conditions
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Asthma
Study Design
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Observational Model Type
COHORT
Study Time Perspective
RETROSPECTIVE
Study Groups
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Asthma group
Patients with asthma
Asthma exacerbation related hospitalization
Intervention Type
OTHER
Evaluate the difference between patients with single and multiple hospitalizations for asthma exacerbation
Interventions
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Asthma exacerbation related hospitalization
Evaluate the difference between patients with single and multiple hospitalizations for asthma exacerbation
Intervention Type
OTHER
Eligibility Criteria
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Inclusion Criteria
* All patients with hospitalization for asthmatic exacerbation according to physician's clinical judgement
* Age greater than 18 years old
* Age greater than 18 years old
Exclusion Criteria
\- Inappropriate diagnosis of asthma exacerbation after evaluation
Minimum Eligible Age
18 Years
Eligible Sex
ALL
Accepts Healthy Volunteers
No
Sponsors
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United Christian Hospital
OTHER
Sponsor Role
collaborator
Princess Margaret Hospital, Hong Kong
OTHER_GOV
Sponsor Role
collaborator
Pamela Youde Nethersole Eastern Hospital
OTHER
Sponsor Role
collaborator
Queen Elizabeth Hospital, Hong Kong
OTHER
Sponsor Role
collaborator
Queen Mary Hospital, Hong Kong
OTHER
Sponsor Role
collaborator
Kwong Wah Hospital
OTHER
Sponsor Role
collaborator
Tseung Kwan O Hospital, Hong Kong
OTHER
Sponsor Role
collaborator
Caritas Medical Centre, Hong Kong
OTHER
Sponsor Role
collaborator
North District Hospital, Hong Kong
UNKNOWN
Sponsor Role
collaborator
Alice Ho Miu Ling Nethersole Hospital
OTHER
Sponsor Role
collaborator
Chinese University of Hong Kong
OTHER
Sponsor Role
lead
Responsible Party
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Ka Pang Chan
Honorary Clinical Tutor
Responsibility Role
PRINCIPAL_INVESTIGATOR
Principal Investigators
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Ka Pang Chan, MBChB
Role: PRINCIPAL_INVESTIGATOR
Chinese University of Hong Kong
Locations
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Chinese University of Hong Kong
Hong Kong, , Hong Kong
Site Status
Countries
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Hong Kong
References
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BACKGROUND
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Reference Type
BACKGROUND
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Reference Type
BACKGROUND
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Reference Type
BACKGROUND
Zeiger RS, Schatz M, Dalal AA, Chen W, Sadikova E, Suruki RY, Kawatkar AA, Qian L. Blood Eosinophil Count and Outcomes in Severe Uncontrolled Asthma: A Prospective Study. J Allergy Clin Immunol Pract. 2017 Jan-Feb;5(1):144-153.e8. doi: 10.1016/j.jaip.2016.07.015. Epub 2016 Sep 21.
Reference Type
BACKGROUND
Price DB, Rigazio A, Campbell JD, Bleecker ER, Corrigan CJ, Thomas M, Wenzel SE, Wilson AM, Small MB, Gopalan G, Ashton VL, Burden A, Hillyer EV, Kerkhof M, Pavord ID. Blood eosinophil count and prospective annual asthma disease burden: a UK cohort study. Lancet Respir Med. 2015 Nov;3(11):849-58. doi: 10.1016/S2213-2600(15)00367-7. Epub 2015 Oct 19.
Reference Type
BACKGROUND
ten Brinke A, Sterk PJ, Masclee AA, Spinhoven P, Schmidt JT, Zwinderman AH, Rabe KF, Bel EH. Risk factors of frequent exacerbations in difficult-to-treat asthma. Eur Respir J. 2005 Nov;26(5):812-8. doi: 10.1183/09031936.05.00037905.
Reference Type
BACKGROUND
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Reference Type
BACKGROUND
Nestor A, Calhoun AC, Dickson M, Kalik CA. Cross-sectional analysis of the relationship between national guideline recommended asthma drug therapy and emergency/hospital use within a managed care population. Ann Allergy Asthma Immunol. 1998 Oct;81(4):327-30. doi: 10.1016/S1081-1206(10)63124-9.
Reference Type
BACKGROUND
Williams LK, Peterson EL, Wells K, Ahmedani BK, Kumar R, Burchard EG, Chowdhry VK, Favro D, Lanfear DE, Pladevall M. Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence. J Allergy Clin Immunol. 2011 Dec;128(6):1185-1191.e2. doi: 10.1016/j.jaci.2011.09.011. Epub 2011 Oct 21.
Reference Type
BACKGROUND
Hasegawa K, Sullivan AF, Tovar Hirashima E, Gaeta TJ, Fee C, Turner SJ, Massaro S, Camargo CA Jr; Multicenter Airway Research Collaboration-36 Investigators. A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department? J Allergy Clin Immunol Pract. 2014 Nov-Dec;2(6):733-40. doi: 10.1016/j.jaip.2014.06.012. Epub 2014 Sep 10.
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BACKGROUND
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Reference Type
BACKGROUND
Turner MO, Noertjojo K, Vedal S, Bai T, Crump S, Fitzgerald JM. Risk factors for near-fatal asthma. A case-control study in hospitalized patients with asthma. Am J Respir Crit Care Med. 1998 Jun;157(6 Pt 1):1804-9. doi: 10.1164/ajrccm.157.6.9708092.
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BACKGROUND
Bai TR, Vonk JM, Postma DS, Boezen HM. Severe exacerbations predict excess lung function decline in asthma. Eur Respir J. 2007 Sep;30(3):452-6. doi: 10.1183/09031936.00165106. Epub 2007 May 30.
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BACKGROUND
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BACKGROUND
Luskin AT, Chipps BE, Rasouliyan L, Miller DP, Haselkorn T, Dorenbaum A. Impact of asthma exacerbations and asthma triggers on asthma-related quality of life in patients with severe or difficult-to-treat asthma. J Allergy Clin Immunol Pract. 2014 Sep-Oct;2(5):544-52.e1-2. doi: 10.1016/j.jaip.2014.02.011. Epub 2014 Jul 3.
Reference Type
BACKGROUND
Sullivan PW, Slejko JF, Ghushchyan VH, Sucher B, Globe DR, Lin SL, Globe G. The relationship between asthma, asthma control and economic outcomes in the United States. J Asthma. 2014 Sep;51(7):769-78. doi: 10.3109/02770903.2014.906607. Epub 2014 Apr 7.
Reference Type
BACKGROUND
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Reference Type
BACKGROUND
Heaney LG, Conway E, Kelly C, Johnston BT, English C, Stevenson M, Gamble J. Predictors of therapy resistant asthma: outcome of a systematic evaluation protocol. Thorax. 2003 Jul;58(7):561-6. doi: 10.1136/thorax.58.7.561.
Reference Type
BACKGROUND
Robinson DS, Campbell DA, Durham SR, Pfeffer J, Barnes PJ, Chung KF; Asthma and Allergy Research Group of the National Heart and Lung Institute. Systematic assessment of difficult-to-treat asthma. Eur Respir J. 2003 Sep;22(3):478-83. doi: 10.1183/09031936.03.00017003.
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BACKGROUND
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Reference Type
BACKGROUND
Related Links
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http://www.cdc.gov/asthma/most_recent_data.htm
Assessed on 28 April 2017
Other Identifiers
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CREC 2017.503
Identifier Type: -
Identifier Source: org_study_id
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