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Observational Study
. 2018 Jan 18;19(1):12.
doi: 10.1186/s12931-018-0719-x.

Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR)

Kjell Larsson  1 , Björn Ställberg  2 , Karin Lisspers  2 , Gunilla Telg  3 , Gunnar Johansson  2 , Marcus Thuresson  4 , Christer Janson  5
Affiliations
Observational Study

Prevalence and management of severe asthma in primary care: an observational cohort study in Sweden (PACEHR)

Kjell Larsson et al. Respir Res. .

Abstract

Background: Severe and uncontrolled asthma is associated with increased risk of exacerbations and death. A substantial proportion of asthma patients have poor asthma control, and a concurrent COPD diagnosis often increases disease burden. The objective of the study was to describe the prevalence and managemant of severe asthma in a Swedish asthma popuöation.

Methods: In this observational cohort study, primary care medical records data (2006-2013) from 36 primary health care centers were linked to data from national mandatory Swedish health registries. The studied population (>18 years) had a record of drug collection for obstructive pulmonary disease (ATC code R03) during 2011-2012, and a physician diagnosed asthma (ICD-10 code J45-J46) prior to drug collection. Severe asthma was classified as collection of high dose inhaled steroid (> 800 budesonide or equivalent per day) and leukotriene receptor antagonist and/or long-acting beta-agonist. Poor asthma control was defined as either collection of ≥600 doses of short-acting beta-agonists, and/or ≥1 exacerbation(s) during the year post index date.

Results: A total of 18,724 asthma patients (mean 49 years, 62.8% women) were included, of whom 17,934 (95.8%) had mild to moderate and 790 (4.2%) had severe asthma. Exacerbations were more prevalent in severe asthma (2.59 [2.41-2.79], Relative Risk [95% confidence interval]; p < 0.001). Poor asthma control was observed for 28.2% of the patients with mild to moderate asthma and for more than half (53.6%) of the patients with severe asthma (<0.001). Prior to index, one in five severe asthma patients had had a contact with secondary care and one third with primary care. A concurrent COPD diagnosis increased disease burden.

Conclusion: Severe asthma was found in 4.2% of asthma patients in Sweden, more than half of them had poor asthma control, and most patients had no regular health care contacts.

Keywords: Asthma prevalence; Severe asthma; Uncontrolled asthma.

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Conflict of interest statement

Ethics approval and consent to participate

The study protocol was approved by the regional ethics committee in Uppsala, Sweden (reference number 2014/446).

Consent for publication

Not applicable.

Competing interests

All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare: K. Larsson has received honoraria for participation in advisory board meetings and lectures from AstraZeneca, Boehringer Ingelheim, Novartis, Chiesi, Orion, TEVA and Takeda. B. Ställberg has served in advisory board meetings, development of educational presentations and for lectures from AstraZeneca, Novartis, Boehringer Ingelheim, Meda and TEVA. K. Lisspers has received speaking fees from AstraZeneca, Novartis, TEVA and Meda. C. Janson has received honoraria for lectures from AstraZeneca, TEVA and Novartis. G. Telg is a full-time employee of the sponsor, AstraZeneca. G. Johansson and M. Thuresson have no conflicts to report.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Study flow chart. Out of 49,408 patients with asthma (ICD10 code J45 or J46) who, during 2011 and 2012, collected respiratory drugs (ATC R03) from the pharmacy 18,724 fulfilled the inclusion criteria, i e were above the age of 18 years, had an asthma diagnosis prior to drug collection and did not have polymyalgia rheumatic or rheumatoid arthritis. Of these 18,724 patients, 790 were classified as having severe asthma and 17,934 as having mild to moderate asthma
Fig. 2
Fig. 2
Poor asthma conttrol assessed by acute exacebations and the collection of more than 600 doses of short-acting beta-2 agonists the year after index date
See this image and copyright information in PMC

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