Patient Characteristics, Management, and Outcomes of Adult Asthma in a Singapore Population: Data from the SDG-CARE Asthma Registry.

IF 2.3 Q2 MEDICINE, GENERAL & INTERNAL

Pragmatic and Observational Research Pub Date : 2024-12-07 eCollection Date: 2024-01-01 DOI:10.2147/POR.S477225

Mariko Siyue Koh, Sean Shao Wei Lam, Xiaomeng Xu, Jun Tian Wu, Priyan Ratnasingham, Ricco Marsel, Marcus Eng Hock Ong, David Bruce Matchar, Ngiap Chuan Tan, Chian Min Loo

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Abstract

Purpose: Patients with asthma in Singapore often have complex patient journeys, with diagnosis and management across various primary and speciality care settings. Real-world population health data is needed to identify care gaps and inform policies.

Patients and methods: This retrospective, longitudinal cohort study assessed real-world data from adults (aged ≥18 years) with asthma in the SingHealth Chronic Obstructive Pulmonary Disease and Asthma Data Mart, an integrated database of electronic medical records of patients who attended primary and/or speciality care clinics in the SingHealth Regional Health System 01/01/2015-12/31/2020. Patients were indexed by first asthma diagnosis and categorized into cohorts of index year. Patient characteristics, asthma management and outcomes were described during baseline (1-year pre-index) and follow-up periods (1-year post-index).

Results: Overall, 21,215 patients were included across 4 cohorts: 2016, N=12,947; 2017, N=3419; 2018, N=2816; 2019, N=2033. Most common baseline asthma medication changed from inhaled corticosteroids (ICS) alone in the 2016 cohort (32.8% [n=4252]) to ICS/long-acting β₂-agonist in the 2019 cohort (33.3% [n=677]). Asthma symptom control (mean [SD] Asthma Control Test scores) improved from 2016 to 2019 during baseline (18.38 [4.93] vs 19.87 [4.56]; p<0.001) and follow-up (18.34 [4.23] vs 21.07 [3.51]; p<0.001). Mean (standard deviation [SD]) number of exacerbations per patient during follow-up decreased from 2016 to 2019 (1.91 [3.11] vs 0.89 [2.07]; p<0.001). Mean (SD) number of emergency department visits per patient during follow-up decreased from 0.21 (0.75) in 2016 to 0.17-0.18 (0.60-0.65; p<0.001) between 2017 and 2019.

Conclusion: Health status at first asthma diagnosis improved for each succeeding cohort from 2016 to 2019, along with improvements in patient management and outcomes. This reflects greater awareness of the condition and improved use of medication and referrals in recent years, suggesting policy changes and their implementation, including promotion of disease awareness and adoption of guideline recommendations, may improve asthma outcomes in Singapore.

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新加坡人群中成人哮喘的患者特征、管理和结果：来自SDG-CARE哮喘登记的数据

目的：新加坡的哮喘患者通常有复杂的患者旅程，在各种初级和专业护理机构中进行诊断和管理。需要真实世界的人口健康数据来确定保健差距并为政策提供信息。患者和方法：这项回顾性、纵向队列研究评估了SingHealth慢性阻塞性肺病和哮喘数据集市（SingHealth Chronic Obstructive Pulmonary Disease and asthma data Mart）中哮喘成人（年龄≥18岁）的真实数据，该数据集市是一个综合数据库，包含2015年1月1日至2020年12月31日在SingHealth区域卫生系统初级和/或专业护理诊所就诊的患者的电子病历。患者以首次哮喘诊断为指标，按指标年份进行分组。在基线期（指数前1年）和随访期（指数后1年）描述患者特征、哮喘管理和结果。结果：总体而言，共纳入4个队列的21,215例患者：2016年，N=12,947；2017年,N = 3419;2018年,N = 2816;2019年,N = 2033。在2016年队列中，最常见的基线哮喘药物从仅吸入性皮质类固醇（ICS）（32.8% [n=4252]）变为2019年队列中ICS/长效β2激动剂（33.3% [n=677]）。哮喘症状控制（平均[SD]哮喘控制测试分数）在基线期间从2016年到2019年有所改善(18.38[4.93]对19.87 [4.56]；结论：从2016年到2019年，每个后续队列首次哮喘诊断时的健康状况都有所改善，患者管理和预后也有所改善。这反映了近年来人们对哮喘的认识有所提高，药物使用和转诊情况有所改善，这表明政策变化及其实施，包括提高疾病意识和采用指南建议，可能会改善新加坡的哮喘结局。

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Pragmatic and Observational Research MEDICINE, GENERAL & INTERNAL-

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期刊介绍： Pragmatic and Observational Research is an international, peer-reviewed, open-access journal that publishes data from studies designed to closely reflect medical interventions in real-world clinical practice, providing insights beyond classical randomized controlled trials (RCTs). While RCTs maximize internal validity for cause-and-effect relationships, they often represent only specific patient groups. This journal aims to complement such studies by providing data that better mirrors real-world patients and the usage of medicines, thus informing guidelines and enhancing the applicability of research findings across diverse patient populations encountered in everyday clinical practice.