- 作者：Ferran Morell ; Teresa Genover ; Xavier Muñ ; oz ; Judith Garcí ; a-Aymerich ; Jaume Ferrer ; Marí ; a-Jesú ; s Cruz
- 关键词：Asthma exacerbation ; Severe asthma exacerbation ; Readmission ; Comorbidity ; Emergency services ; Hospital admission ; Epidemiology
- 刊名：Archivos de Bronconeumología (English Edition)
- 出版年：2008
- 出版时间：2008
- 年：2008
- 卷：44
- 期：6
- 页码：303-311
- 全文大小：171 K
Objective
The aim of this study was to determine theincidence and clinical characteristics of asthma exacerbationsseen by emergency services in Barcelona, Spain (the ASMAB-I study).Patients and Methods
The emergency services consideredin the study served a population of 1 203 598 inhabitants agedover 14 years. Episodes treated in hospital emergencydepartments and by emergency services called to patients'homes over a period of 129 days were included in the study.
Results
In total, 831 episodes of exacerbation wereidentified; 523 were seen in 3 university hospitals, 113 insecondary hospitals, and 195 by emergency services at thepatient's home. Twenty of the patients seen at home weresubsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of0.53 exacerbations per 100 000 inhabitants (95 % confidenceinterval, 0.46-0.56 exacerbations/100 000 inhabitants) and 8.2 per 100 000 asthmatic patients (95 % confidence interval,6.89-8.41 exacerbations/100 000 asthmatic patients). Of the276 episodes treated between Monday and Thursday inuniversity hospitals, 66 patients (24 % ) reported acute onsetand 14 (5 % ) sudden onset. Only 85 patients (31 % ) regularlyused inhaled corticosteroids and only 33 (12 % ) added oralcorticosteroids in the 12 hours prior to consulting emergencyservices. In 16 % of cases the episode was classified as severeand in 3 % near fatal. Eighty-two patients (30 % ) were ultimatelyadmitted to hospital: 12 % of mild exacerbations, 39 % ofmoderate exacerbations, 62 % of severe episodes, and 100 % of near-fatal episodes. The Charlson comorbidity index washigher in patients admitted to hospital (P<.001). In the 28 patients readmitted to hospital (10 % ), antibiotics (P<.001)and ipratropium bromide (P<.0001) had been prescribed lessoften at the time of discharge after the first hospital admission.
Conclusions
The rate of asthma exacerbation establishedin this study may be a useful indicator of the degree of controlof the disease and may serve as a reference to confirm futureshort-term or lasting increases in asthma exacerbation. Rapidonset (acute or sudden) is common and many patients are notreceiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospitaladmission is related to severity and comorbidity. Patients whoare readmitted to hospital had less often received antibiotictreatment and ipratropium bromide when dischargedpreviously.