Allergy Asthma Immunol Res.  2020 May;12(3):485-495. 10.4168/aair.2020.12.3.485.

Hospitalization Due to Asthma Exacerbation: A China Asthma Research Network (CARN) Retrospective Study in 29 Provinces Across Mainland China

Affiliations
  • 1Department of Pulmonary and Critical Care Medicine, China-Japan Friendship Hospital, Beijing, China. jiangtao_l@263.net
  • 2Department of Respiration, Qingdao Municipal Hospital, Qingdao, Shandong, China.
  • 3Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China.
  • 4Department of Respiration, The Second Hospital of Hebei Medical University, Shijiazhuang, China.
  • 5Department of Respiration, Qinghai People's Hospital, Xining, China.
  • 6Department of Respiratory Diseases, General Hospital of Shenyang Military Command, Shenyang, China.
  • 7Department of Respiration, The First Affiliated Hospital of Lanzhou University, Lanzhou, China.
  • 8Department of Pulmonary and Critical Care Medicine, The Second Hospital of Jilin University, Changchun, China.
  • 9Department of Respiration, Tongji Hospital, Wuhan, China.
  • 10Department of Respiration, Xinqiao Hospital, Third Military Medical University, Chongqing, China.
  • 11Department of Respiration, General Hospital of Ningxia Medical University, Yinchuan, China.
  • 12Department of Pulmonary and Critical Care Medicine, Inner Mongolia People's Hospital, Hohhot, China.
  • 13Department of Respiration, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
  • 14Department of Respiration, Henan Provincial People's Hospital, Zhengzhou, China.
  • 15Department of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China.
  • 16Department of Respiration, The First Affiliated Hospital of Fujian Medical University, Fuzhou, China.
  • 17Department of Respiration, Xiangya Hospital, Changsha, China.
  • 18Department of Pulmonary and Critical Care Medicine, People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, China.
  • 19Department of Respiration, The First Affiliated Hospital of Harbin Medical University, Harbin China.
  • 20Department of Respiration, Guizhou Provincial People's Hospital, Guiyang, China.
  • 21Department of Respiration, Shanghai Central Hospital, Shanghai, China.
  • 22Department of Respiration, Tianjin First Central Hospital, Tianjin, China.
  • 23Department of Respiration, The First Affiliated Hospital of Nanchang University, Nanchang, China.
  • 24Department of Respiration, Hainan General Hospital, Haikou, China.
  • 25Department of Respiration, Kunming General Hospital of the People's Liberation Army, Kunming, China.
  • 26Department of Respiration, The First Affiliated Hospital of Anhui Medical University, Hefei, China.
  • 27Department of Respiration, Nanfang Hospital, Guangzhou, China.
  • 28Department of Respiration, Shanxi Bethune Hospital, Taiyuan, China.
  • 29Department of Respiration, The First Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou, China.

Abstract

PURPOSE
Details of patients hospitalized for asthma exacerbation in mainland China are lacking. To improve disease control and reduce economic burden, a large sample survey among this patient population is indispensable. This study aimed to investigate the clinical characteristics and outcomes of such patients.
METHODS
A retrospective study was conducted on patients hospitalized for asthma exacerbation in 29 hospitals of 29 regions in mainland China during the period 2013 to 2014. Demographic features, pre-admission conditions, exacerbation details, and outcomes were summarized. Risk factors for exacerbation severity were analyzed.
RESULTS
There were 3,240 asthmatic patients included in this study (57.7% females, 42.3% males). Only 28.0% used daily controller medications; 1,287 (39.7%) patients were not currently on inhaled corticosteroids. Acute upper airway infection was the most common trigger of exacerbation (42.3%). Patients with severe to life-threatening exacerbation tended to have a longer disease course, a smoking history, and had comorbidities such as hypertension, chronic obstructive pulmonary disease (COPD), and food allergy. The multivariate analysis showed that smoking history, comorbidities of hypertension, COPD, and food allergy were independent risk factors for more severe exacerbation. The number of patients hospitalized for asthma exacerbation varied with seasons, peaking in March and September. Eight patients died during the study period (mortality 0.25%).
CONCLUSIONS
Despite enhanced education on asthma self-management in China during recent years, few patients were using daily controller medications before the onset of their exacerbation, indicating that more educational efforts and considerations are needed. The findings of this study may improve our understanding of hospital admission for asthma exacerbation in mainland China and provide evidence for decision-making.

Keyword

Asthma; disease progression; hospitalization; inpatients; risk factors; seasonal variation; medication adherence; mortality

MeSH Terms

Adrenal Cortex Hormones
Asthma*
China*
Comorbidity
Disease Progression
Education
Female
Food Hypersensitivity
Hospitalization*
Humans
Hypertension
Inpatients
Medication Adherence
Mortality
Multivariate Analysis
Pulmonary Disease, Chronic Obstructive
Retrospective Studies*
Risk Factors
Seasons
Self Care
Smoke
Smoking
Adrenal Cortex Hormones
Smoke

Figure

  • Fig. 1 Flowchart of the study.

  • Fig. 2 Sex proportions in patients with mild-to-moderate exacerbation and severe-to-life-threatening exacerbation discriminated by the smoking history.

  • Fig. 3 Seasonality of hospital admission for asthma exacerbation.%MRH, % of monthly respiratory hospitalizations.


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