Retrospective cohort analysis of healthcare claims in the United States characterising asthma exacerbations in paediatric patients

Abstract

Background: Asthma is the most common chronic disease in childhood and places a significant burden on public and private health systems. This retrospective cohort analysis utilised administrative healthcare claims data (US Clinformatics™ Multiplan database; compliant with the US Department of Health & Human Services Health Insurance Portability and Accountability Act) to characterise asthma exacerbations requiring intervention in a US paediatric patient population.

Methods: Patients aged > 1-17 years with a recorded asthma diagnosis and receiving treatment were identified in the US Clinformatics™ Multiplan database over a 9-year period (2004-2012). Both incident and prevalent cases of asthma were included, with the most recently recorded asthma diagnosis designated as the index date. The 12-month period following the index date was analysed for asthma exacerbations, defined as an event requiring treatment with systemic corticosteroid or resulting in an asthma-related hospitalisation or emergency department visit.

Results: Data from 734,114 children with asthma (41.5 % females, 58.5 % males) were analysed, of this cohort 34.4 % experienced ≥ 1 exacerbation during the follow-up period. The proportion who experienced ≥ 1 exacerbation increased from 28.9 % in 2004 to 36.3 % in 2012, based on the reported index date. Their mean annual exacerbation frequency was 1.4; 85.8 % of exacerbations were defined by systemic corticosteroids use. A consistent trend of increased exacerbation incidence in the fall and early winter was observed, in particular exacerbations defined by systemic corticosteroid use. A greater proportion of asthma-related hospitalisations were associated with younger age.

Conclusions: Approximately one-third of children experienced ≥ 1 exacerbation in real-world clinical practice. A targeted treatment approach with a focus on those with a history of recurrent exacerbations is recommended to improve asthma control. This targeted approach could also minimise the frequent systemic corticosteroid exposure particularly at an early age when side effects of systemic corticosteroids are more pronounced.

Keywords: Asthma; Exacerbations; Paediatric; Systemic corticosteroids.

Fig. 1

Exacerbation frequency during the 12-month follow-up period by a age group and b gender

Fig. 2

Asthma exacerbations in paediatric patients with asthma by month, overall and by exacerbation type

Fig. 3

Proportion of patients with ≥ 1 exacerbation during the 12-month follow-up by a age and b gender. *The subset of asthma patients on controller medications was defined as follows: patients who had received an asthma controller medication (LTRA, ICS, ICS/LABA, OCS or injectable steroid, omalizumab, theophylline) within +/-3 months of the index date