Rationale: The National Heart, Lung, and Blood Institute (NHLBI) recommend a stepwise approach to asthma management, with the goals of maintaining asthma control and reducing exacerbations. Although asthma treatments reduce the frequency of exacerbations, they still occur. We aimed to characterize the treated United States of America (US) adult asthma population, including those experiencing exacerbations, in terms of socio-demographics, clinical characteristics, and healthcare resource utilization (HRU).
Patients and Methods: A retrospective cohort of asthma patients aged ≥ 18 years on 01 January 2014 with ≥ 1 ICD-9 asthma code (493.xx) enrolled in a US healthcare claims database during 2013– 2014. Patients who had ≥ 2 asthma medication dispensings during 2013 (baseline), including ≥ 1 in the 90-day period before index date, were classified according to NHLBI step. Patients with chronic obstructive pulmonary disease, cystic fibrosis, or lung cancer diagnoses were excluded. Demographics, comorbidities, clinical characteristics, and HRU were described during baseline. Exacerbations and HRU were described during 2014 (follow-up period).
Results: In total, 72,156 patients were included; 10,590 (14.7%) had ≥ 1 exacerbation during follow-up. Approximately 44% of patients were classified as NHLBI Steps 1– 2, 41% as Steps 3– 4, and 11% as Steps 5– 6. Exacerbation frequency increased with step (Steps 1, 2, and 3: 12– 14%; Steps 4, 5, and 6: 16– 26%). Compared with the overall population during baseline, patients with an exacerbation had similar demographics, but differences were observed for comorbid allergic rhinitis (46.4% vs 40.1%, respectively), blood eosinophil counts ≥ 300 cells/μL (45.5% vs 39.6%, respectively), and asthma-related healthcare encounters (62.9% vs 52.4%, respectively). Overall, asthma-related HRU during follow-up increased with NHLBI step.
Conclusion: Exacerbations were observed among patients classified at each NHLBI step and were more frequent with increasing step. Exacerbations and asthma-related HRU highlight the continued unmet need in the treated US asthma population.

Keywords: asthma, clinical traits, real-world, administrative claims, healthcare costs, healthcare resource utilization


中文翻译：

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美国数据库中经历恶化的治疗哮喘患者的特征：一项回顾性队列研究

理由：美国国家心肺血液研究所 (NHLBI) 建议采用循序渐进的哮喘管理方法，目标是维持哮喘控制并减少哮喘发作。尽管哮喘治疗降低了恶化的频率，但它们仍然会发生。我们旨在根据社会人口学、临床特征和医疗资源利用 (HRU) 来描述接受治疗的美国 (US) 成人哮喘人群，包括那些经历恶化的人群。
患者和方法：2014 年 1 月 1 日年龄 ≥ 18 岁且具有 ≥ 1 个 ICD-9 哮喘代码 (493.xx) 的哮喘患者的回顾性队列在 2013-2014 年期间被纳入美国医疗保健索赔数据库。在 2013 年期间有 ≥ 2 次哮喘药物分配的患者 (基线），包括索引日期前 90 天内≥1 次，按 NHLBI 步骤分类。排除患有慢性阻塞性肺病、囊性纤维化或肺癌诊断的患者。在基线期间描述了人口统计学、合并症、临床特征和 HRU。2014 年（随访期）描述了恶化和 HRU。
结果：总共包括 72,156 名患者；10,590 (14.7%) 人在随访期间出现 ≥ 1 次恶化。大约 44% 的患者被归类为 NHLBI 第 1-2 步，41% 为第 3-4 步，11% 为第 5-6 步。恶化频率随步数增加（第 1、2 和 3 步：12-14%；步骤 4、5 和 6：16–26%）。与基线时的总体人群相比，急性加重患者的人口统计学特征相似，但在合并过敏性鼻炎（分别为 46.4% 和 40.1%）、血嗜酸性粒细胞计数 ≥ 300 个细胞/μL（分别为 45.5% 和 39.6%）方面观察到差异)，以及与哮喘相关的医疗保健经历（分别为 62.9% 和 52.4%）。总体而言，随访期间哮喘相关 HRU 随 NHLBI 步骤的增加而增加。
结论：在每个 NHLBI 步骤分类的患者中观察到恶化，并且随着步骤的增加而更频繁。恶化和哮喘相关的 HRU 突出了美国哮喘治疗人群中持续未满足的需求。

关键词：哮喘，临床特征，真实世界，行政索赔，医疗成本，医疗资源利用