Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice

David Price, Andrew M. Wilson, Alison Chisholm, Anna Rigazio, Anne Burden, Michael Thomas, Christine King

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Abstract

PURPOSE: Acute, severe asthma exacerbations can be difficult to predict and thus prevent. Patients who have frequent exacerbations are of particular concern. Practical exacerbation predictors are needed for these patients in the primary-care setting.

PATIENTS AND METHODS: Medical records of 130,547 asthma patients aged 12-80 years from the UK Optimum Patient Care Research Database and Clinical Practice Research Datalink, 1990-2013, were examined for 1 year before (baseline) and 1 year after (outcome) their most recent blood eosinophil count. Baseline variables predictive (P<0.05) of exacerbation in the outcome year were compared between patients who had two or more exacerbations and those who had no exacerbation or only one exacerbation, using uni- and multivariable logistic regression models. Exacerbation was defined as asthma-related hospital attendance/admission (emergency or inpatient) or acute oral corticosteroid (OCS) course.

RESULTS: Blood eosinophil count >400/µL (versus ≤400/µL) increased the likelihood of two or more exacerbations >1.4-fold (odds ratio [OR]: 1.48 (95% confidence interval [CI]: 1.39, 1.58); P<0.001). Variables that significantly increased the odds by up to 1.4-fold included increasing age (per year), female gender (versus male), being overweight or obese (versus normal body mass index), being a smoker (versus nonsmoker), having anxiety/depression, diabetes, eczema, gastroesophageal reflux disease, or rhinitis, and prescription for acetaminophen or nonsteroidal anti-inflammatory drugs. Compared with treatment at British Thoracic Society step 2 (daily controller ± reliever), treatment at step 0 (none) or 1 (as-needed reliever) increased the odds by 1.2- and 1.6-fold, respectively, and treatment at step 3, 4, or 5 increased the odds by 1.3-, 1.9-, or 3.1-fold, respectively (all P<0.05). Acute OCS use was the single best predictor of two or more exacerbations. Even one course increased the odds by more than threefold (OR: 3.75 [95% CI: 3.50, 4.01]; P<0.001), and three or more courses increased the odds by >25-fold (OR: 25.7 [95% CI: 23.9, 27.6]; P<0.001).

CONCLUSION: Blood eosinophil count and several other variables routinely available in patient records may be used to predict frequent asthma exacerbations.

Original languageEnglish
Pages (from-to)1-12
Number of pages12
JournalJournal of Asthma and Allergy
Volume9
DOIs
Publication statusPublished - 7 Jan 2016

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Eosinophils
Asthma
Odds Ratio
Confidence Intervals
Research
Medical Records
Primary Health Care
Patient Care
Databases

Keywords

  • exacerbator
  • risk
  • multiple
  • hospitalization

Cite this

Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice. / Price, David; Wilson, Andrew M.; Chisholm, Alison; Rigazio, Anna; Burden, Anne; Thomas, Michael; King, Christine.

In: Journal of Asthma and Allergy, Vol. 9, 07.01.2016, p. 1-12.

Research output: Contribution to journalArticle

Price, David ; Wilson, Andrew M. ; Chisholm, Alison ; Rigazio, Anna ; Burden, Anne ; Thomas, Michael ; King, Christine. / Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice. In: Journal of Asthma and Allergy. 2016 ; Vol. 9. pp. 1-12.
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abstract = "PURPOSE: Acute, severe asthma exacerbations can be difficult to predict and thus prevent. Patients who have frequent exacerbations are of particular concern. Practical exacerbation predictors are needed for these patients in the primary-care setting.PATIENTS AND METHODS: Medical records of 130,547 asthma patients aged 12-80 years from the UK Optimum Patient Care Research Database and Clinical Practice Research Datalink, 1990-2013, were examined for 1 year before (baseline) and 1 year after (outcome) their most recent blood eosinophil count. Baseline variables predictive (P<0.05) of exacerbation in the outcome year were compared between patients who had two or more exacerbations and those who had no exacerbation or only one exacerbation, using uni- and multivariable logistic regression models. Exacerbation was defined as asthma-related hospital attendance/admission (emergency or inpatient) or acute oral corticosteroid (OCS) course.RESULTS: Blood eosinophil count >400/µL (versus ≤400/µL) increased the likelihood of two or more exacerbations >1.4-fold (odds ratio [OR]: 1.48 (95{\%} confidence interval [CI]: 1.39, 1.58); P<0.001). Variables that significantly increased the odds by up to 1.4-fold included increasing age (per year), female gender (versus male), being overweight or obese (versus normal body mass index), being a smoker (versus nonsmoker), having anxiety/depression, diabetes, eczema, gastroesophageal reflux disease, or rhinitis, and prescription for acetaminophen or nonsteroidal anti-inflammatory drugs. Compared with treatment at British Thoracic Society step 2 (daily controller ± reliever), treatment at step 0 (none) or 1 (as-needed reliever) increased the odds by 1.2- and 1.6-fold, respectively, and treatment at step 3, 4, or 5 increased the odds by 1.3-, 1.9-, or 3.1-fold, respectively (all P<0.05). Acute OCS use was the single best predictor of two or more exacerbations. Even one course increased the odds by more than threefold (OR: 3.75 [95{\%} CI: 3.50, 4.01]; P<0.001), and three or more courses increased the odds by >25-fold (OR: 25.7 [95{\%} CI: 23.9, 27.6]; P<0.001).CONCLUSION: Blood eosinophil count and several other variables routinely available in patient records may be used to predict frequent asthma exacerbations.",
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author = "David Price and Wilson, {Andrew M.} and Alison Chisholm and Anna Rigazio and Anne Burden and Michael Thomas and Christine King",
note = "Acknowledgments We gratefully acknowledge Vicky Thomas (principal statistician and Head of Statistics, Cambridge Research Support, Ltd), Dr Marjan Kerkhof (senior researcher/epidemiologist, Research in Real-Life), Derek Skinner (data analyst, Optimum Patient Care), and Maria Batsiou (statistician, Cambridge Research Support Ltd ) for additional statistical support.",
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T1 - Predicting frequent asthma exacerbations using blood eosinophil count and other patient data routinely available in clinical practice

AU - Price, David

AU - Wilson, Andrew M.

AU - Chisholm, Alison

AU - Rigazio, Anna

AU - Burden, Anne

AU - Thomas, Michael

AU - King, Christine

N1 - Acknowledgments We gratefully acknowledge Vicky Thomas (principal statistician and Head of Statistics, Cambridge Research Support, Ltd), Dr Marjan Kerkhof (senior researcher/epidemiologist, Research in Real-Life), Derek Skinner (data analyst, Optimum Patient Care), and Maria Batsiou (statistician, Cambridge Research Support Ltd ) for additional statistical support.

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N2 - PURPOSE: Acute, severe asthma exacerbations can be difficult to predict and thus prevent. Patients who have frequent exacerbations are of particular concern. Practical exacerbation predictors are needed for these patients in the primary-care setting.PATIENTS AND METHODS: Medical records of 130,547 asthma patients aged 12-80 years from the UK Optimum Patient Care Research Database and Clinical Practice Research Datalink, 1990-2013, were examined for 1 year before (baseline) and 1 year after (outcome) their most recent blood eosinophil count. Baseline variables predictive (P<0.05) of exacerbation in the outcome year were compared between patients who had two or more exacerbations and those who had no exacerbation or only one exacerbation, using uni- and multivariable logistic regression models. Exacerbation was defined as asthma-related hospital attendance/admission (emergency or inpatient) or acute oral corticosteroid (OCS) course.RESULTS: Blood eosinophil count >400/µL (versus ≤400/µL) increased the likelihood of two or more exacerbations >1.4-fold (odds ratio [OR]: 1.48 (95% confidence interval [CI]: 1.39, 1.58); P<0.001). Variables that significantly increased the odds by up to 1.4-fold included increasing age (per year), female gender (versus male), being overweight or obese (versus normal body mass index), being a smoker (versus nonsmoker), having anxiety/depression, diabetes, eczema, gastroesophageal reflux disease, or rhinitis, and prescription for acetaminophen or nonsteroidal anti-inflammatory drugs. Compared with treatment at British Thoracic Society step 2 (daily controller ± reliever), treatment at step 0 (none) or 1 (as-needed reliever) increased the odds by 1.2- and 1.6-fold, respectively, and treatment at step 3, 4, or 5 increased the odds by 1.3-, 1.9-, or 3.1-fold, respectively (all P<0.05). Acute OCS use was the single best predictor of two or more exacerbations. Even one course increased the odds by more than threefold (OR: 3.75 [95% CI: 3.50, 4.01]; P<0.001), and three or more courses increased the odds by >25-fold (OR: 25.7 [95% CI: 23.9, 27.6]; P<0.001).CONCLUSION: Blood eosinophil count and several other variables routinely available in patient records may be used to predict frequent asthma exacerbations.

AB - PURPOSE: Acute, severe asthma exacerbations can be difficult to predict and thus prevent. Patients who have frequent exacerbations are of particular concern. Practical exacerbation predictors are needed for these patients in the primary-care setting.PATIENTS AND METHODS: Medical records of 130,547 asthma patients aged 12-80 years from the UK Optimum Patient Care Research Database and Clinical Practice Research Datalink, 1990-2013, were examined for 1 year before (baseline) and 1 year after (outcome) their most recent blood eosinophil count. Baseline variables predictive (P<0.05) of exacerbation in the outcome year were compared between patients who had two or more exacerbations and those who had no exacerbation or only one exacerbation, using uni- and multivariable logistic regression models. Exacerbation was defined as asthma-related hospital attendance/admission (emergency or inpatient) or acute oral corticosteroid (OCS) course.RESULTS: Blood eosinophil count >400/µL (versus ≤400/µL) increased the likelihood of two or more exacerbations >1.4-fold (odds ratio [OR]: 1.48 (95% confidence interval [CI]: 1.39, 1.58); P<0.001). Variables that significantly increased the odds by up to 1.4-fold included increasing age (per year), female gender (versus male), being overweight or obese (versus normal body mass index), being a smoker (versus nonsmoker), having anxiety/depression, diabetes, eczema, gastroesophageal reflux disease, or rhinitis, and prescription for acetaminophen or nonsteroidal anti-inflammatory drugs. Compared with treatment at British Thoracic Society step 2 (daily controller ± reliever), treatment at step 0 (none) or 1 (as-needed reliever) increased the odds by 1.2- and 1.6-fold, respectively, and treatment at step 3, 4, or 5 increased the odds by 1.3-, 1.9-, or 3.1-fold, respectively (all P<0.05). Acute OCS use was the single best predictor of two or more exacerbations. Even one course increased the odds by more than threefold (OR: 3.75 [95% CI: 3.50, 4.01]; P<0.001), and three or more courses increased the odds by >25-fold (OR: 25.7 [95% CI: 23.9, 27.6]; P<0.001).CONCLUSION: Blood eosinophil count and several other variables routinely available in patient records may be used to predict frequent asthma exacerbations.

KW - exacerbator

KW - risk

KW - multiple

KW - hospitalization

U2 - 10.2147/JAA.S97973

DO - 10.2147/JAA.S97973

M3 - Article

VL - 9

SP - 1

EP - 12

JO - Journal of Asthma and Allergy

JF - Journal of Asthma and Allergy

SN - 1178-6965

ER -