- Title
- International variation in severe exacerbation rates in patients with severe asthma
- Creator
- Lee, Tae Yoon; Price, David; Pfeffer, Paul E.; Mahboub, Bassam; Perng Steve, Diahn-Warng; Cosio, Borja G.; Perez-de-Llano, Luis; Al-Lehebi, Riyad; Larenas-Linnemann, Desiree; Al-Ahmad, Mona; Rhee, Chin Kook; Iwanaga, Takashi; Yadav, Chandra Prakash; Heffler, E; Canonica, GW; Costello, R; Papadopoulos, NG; Papaioannou, AI; Porsbjerg, CM; Torres-Duque, CA; Christoff, GC; Popov, TA; Hew, M; Roy, Rupsa; Peters, M; Gibson, Peter G.; Maspero, J; Bergeron, C; Cerda, S; Contreras Contreras, EA; Chen, W; Sadatsafavi, M; Lim, Laura Huey Mein; Wang, Eileen; Wechsler, Michael E.; Jackson, David J.; Busby, John; Heaney, Liam G.
- Relation
- Chest Vol. 166, Issue 1, p. 28-38
- Publisher Link
- http://dx.doi.org/10.1016/j.chest.2024.02.029
- Publisher
- American College of Chest Physicians
- Resource Type
- journal article
- Date
- 2024
- Description
- BACKGROUND: Exacerbation frequency strongly influences treatment choices in patients with severe asthma. RESEARCH QUESTION: What is the extent of the variability of exacerbations rate across countries and its implications in disease management? STUDY DESIGN AND METHODS: We retrieved data from the International Severe Asthma Registry, an international observational cohort of patients with a clinical diagnosis of severe asthma. We identified patients aged ≥18 years who did not initiate any biologics prior to baseline visit. A severe exacerbation was defined as the use of oral corticosteroids for ≥3 days or asthma-related hospitalization/emergency room visit. A series of negative binomial models were applied to estimate country-specific severe exacerbation rates during 365 days of follow-up, starting from a naïve model with country as the only variable, to an adjusted model with country as a random-effect term and patient and disease characteristics as independent variables. RESULTS: The final sample included 7,510 patients from 17 countries (56% from the United States), contributing to 1,939 severe exacerbations (0.27/person-year). There was large between-country variation in observed severe exacerbation rate (min: 0.04 [Argentina], max:0.88 [Saudi Arabia], interquartile range [IQR]: 0.13-0.54), which remained substantial after adjusting for patient characteristics and sampling variability (IQR: 0.16-0.39). INTERPRETATION: Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies. CLINICAL TRIAL REGISTRATION NUMBER: N/A.
- Subject
- asthma; country; heterogeneity; prediction; severe exacerbation; SDG 3; Sustainable Development Goals
- Identifier
- http://hdl.handle.net/1959.13/1508141
- Identifier
- uon:56095
- Identifier
- ISSN:0012-3692
- Language
- eng
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