Kerry L Hancock, Sinthia Bosnic-Anticevich, John D Blakey, Mark Hew, Li Ping Chung, Biljana Cvetkovski, Scott Claxton, Peter Del Fante, Eve Denton, Joe Doan, Kanchanamala Ranasinghe, Lucy Morgan, Anita Sharma, Peter K Smith, Deb Stewart, Philip J Thompson, Russell Wiseman, John W Upham, Kwok Y Yan, Victoria Carter, Kiranjeet Dhillon, Florian Heraud, Thao Le, Rebecca Vella, David Price
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OPCRDA is a real-world database with >800,000 medical records from Australian primary care practices. Outcomes were severe asthma exacerbations in Australian adults, over a 12-month period, stratified by Global Initiative for Asthma (GINA) treatment intensity steps, and steroid associated comorbidities.</p><p><strong>Results: </strong>Of the 7868 adults treated for asthma, 19% experienced at least one severe exacerbation in the last 12-months. Severe exacerbation frequency increased with treatment intensity (≥1 severe exacerbation GINA 1 13%; GINA 4 23%; GINA 5a 33% and GINA 5b 28%). Questionnaire participants reported higher rates of severe exacerbations than suggested from their EMR (32% vs 23%) especially in steps 1, 4 and 5. 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引用次数: 3
摘要
简介:哮喘是澳大利亚人口的一个重大负担。了解严重恶化率和成人诊断哮喘的类固醇相关负担，将为如何减少这种情况提供见解。方法:回顾性使用澳大利亚最佳患者护理研究数据库(OPCRDA)的电子病历(EMR)和问卷调查。OPCRDA是一个真实世界的数据库，拥有来自澳大利亚初级保健实践的超过80万份医疗记录。结果是澳大利亚成年人在12个月的时间内严重哮喘恶化，按全球哮喘倡议(GINA)治疗强度步骤和类固醇相关合并症分层。结果:在7868名接受哮喘治疗的成年人中，19%在过去12个月内至少经历过一次严重恶化。严重加重频率随治疗强度增加而增加(≥1次严重加重GINA 1 13%;吉娜4 23%;GINA 5a 33%， GINA 5b 28%)。问卷参与者报告的严重恶化率高于EMR (32% vs 23%)，特别是在步骤1、4和5中。反复暴露于类固醇的患者骨质疏松症(OR 1.95, 95% CI 1.43-2.66)和睡眠呼吸暂停(OR 1.78, 95% CI 1.30-2.46)的风险增加。结论:与其他第一世界国家相比，澳大利亚GINA 1、4、5a和5b哮喘患者有较高的严重加重率和类固醇相关负担，这些患者需要替代策略或可能的专家评估来更好地管理他们的病情。
Characterisation of the Australian Adult Population Living with Asthma: Severe - Exacerbation Frequency, Long-Term OCS Use and Adverse Effects.
Introduction: Asthma poses a significant burden for the Australian population. Understanding severe exacerbation rates, and steroid-related burden for adults diagnosed with asthma stands to offer insights into how this could be reduced.
Methods: Electronic medical records (EMR) and questionnaires from the Optimum Patient Care Research Database Australia (OPCRDA) were utilised retrospectively. OPCRDA is a real-world database with >800,000 medical records from Australian primary care practices. Outcomes were severe asthma exacerbations in Australian adults, over a 12-month period, stratified by Global Initiative for Asthma (GINA) treatment intensity steps, and steroid associated comorbidities.
Results: Of the 7868 adults treated for asthma, 19% experienced at least one severe exacerbation in the last 12-months. Severe exacerbation frequency increased with treatment intensity (≥1 severe exacerbation GINA 1 13%; GINA 4 23%; GINA 5a 33% and GINA 5b 28%). Questionnaire participants reported higher rates of severe exacerbations than suggested from their EMR (32% vs 23%) especially in steps 1, 4 and 5. Patients repeatedly exposed to steroids had an increased risk of osteoporosis (OR 1.95, 95% CI 1.43-2.66) and sleep apnoea (OR 1.78, 95% CI 1.30-2.46).
Conclusion: The Australian population living with GINA 1, 4, 5a and 5b asthma have high severe exacerbation rates and steroid-related burden, especially when compared to other first world countries, with these patients needing alternative strategies or possibly specialist assessment to better manage their condition.
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.
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