Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization

Background: The risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients who experience asthma exacerbations. We also assessed potential triggers of exacerbations and possible predictors of hospitalization. Methods: A retrospective, noninterventional cohort study was conducted in adult patients who attended the emergency department of a tertiary hospital with an asthma exacerbation during 2014. Results: The study population comprised 831 patients (888 events). Most episodes occurred in January and May. Respiratory infection was the trigger in 523 events. In 34.21% of cases, the eosinophil count was ≥260/mm3 (≥400/mm3 in 20.7%), which was significantly associated with allergic asthma (P<.0001). The risk factors for hospitalization were older age (OR, 1.58; 95%CI, 1.46-1.71), no previous diagnosis of asthma (OR, 1.40; 95%CI, 1.06-1.86), poorly controlled asthma (OR, 1.78; 95%CI, 1.10-2.88), respiratory infection (OR, 2.65; 95%CI, 1.95-3.62), and severe exacerbation with more treatment requirements. The rate of hospitalization was significantly lower in patients with ≥400 eosinophils/mm3 (P<.001). Conclusion: Older age, absence of a previous asthma diagnosis, uncontrolled disease, and concomitant chronic obstructive pulmonary disease are frequent among patients presenting at the emergency department with asthma exacerbations. Various features were associated with a higher risk of admission. Blood eosinophilia should be considered a marker of asthma, but not a predictor of hospitalization (AU)

Introducción: Los factores de riesgo de las exacerbaciones de asma no se conocen por completo. El objetivo de este estudio fue determinar las características epidemiológicas y clínicas de los pacientes con exacerbaciones de asma, los potenciales factores desencadenantes y los posibles predictores de hospitalización. Métodos: Se llevó a cabo un estudio de cohorte retrospectivo, no intervencionista, en pacientes adultos que acudieron al Servicio de Urgencias de un hospital terciario con una exacerbación de asma durante el año 2014. Resultados: Se incluyeron 831 pacientes (888 eventos). El mayor número de episodios ocurrió en Enero y Mayo. La infección respiratoria se consideró como desencadenante en 523 eventos. 34,21% tenían ≥260 eosinófilos/mm3 (20,7% ≥ 400 eosinófilos/mm3), estando lo cual asociado significativamente con el asma alérgica (p<0,0001). Los factores de riesgo para la hospitalización fueron: edad avanzada [OR: 1,58 (IC 95%: 1,46 a 1,71)]; ausencia de diagnóstico previo de asma [OR: 1,40 (IC 95%: 1,06-1,86)]; mal control del asma [OR: 1,78 (IC 95%: 1,10-2,88)]; infección respiratoria [OR: 2,65 (IC 95%: 1,95-3,62)]; y crisis graves con mayor necesidad de tratamiento. En los asmáticos con ≥ 400 eosinófilos/mm3, la tasa de hospitalización fue menor (p <0,001). Conclusión: La edad avanzada, la ausencia de un diagnóstico de asma previo, el mal control de la enfermedad o el padecer EPOC de forma concomitante son frecuentes entre los pacientes que acuden al Servicio de Urgencias con exacerbaciones de asma. Se detectaron algunas características asociadas con un mayor riesgo de ingreso. La eosinofilia periférica debe ser considerada como un marcador de asma, pero no como un predictor de la hospitalización (AU)

Asthma exacerbations in a tertiary hospital: clinical features, triggers, and risk factors for hospitalization.

BACKGROUND: Risk factors for asthma exacerbations are not fully understood. The aim of this study was to determine the epidemiological and clinical characteristics of patients with an asthma exacerbation, potential triggers, and possible predictors of hospitalization. METHODS: A retrospective, non-interventional cohort study was conducted in adult patients who attended the Emergency Department of a tertiary hospital with an asthma exacerbation during 2014. RESULTS: 831 patients (888 events) were included. The highest number of episodes occurred in January and May. Respiratory infection was considered the trigger in 523 events. 34.21% had ≥260 eosinophils/mm3 (20.7%≥400 eosinophils/mm3), significantly associated with allergic asthma (p<0.0001). Risk factors for hospitalization were: older age [OR:1.58 (95% CI 1.46-1.71)]; no previous diagnosis of asthma [OR:1.40(95% CI 1.06-1.86)]; poorly controlled asthma[OR:1.78 (95% CI 1.10-2.88)]; respiratory infection [OR:2.65 (95% CI 1.95-3.62)]; and severe crisis with more treatment requirements. Of those asthmatics with ≥400 eosinophils/mm3, the rate of hospitalization was lower (p<0.001). CONCLUSION: Older age, absence of a previous asthma diagnosis, uncontrolled disease or concomitant COPD are frequent among patients presenting to the ED with asthma exacerbations. There were some features associated with higher risk of admission. Blood eosinophilia should be considered as a marker of asthma, but not as a predictor of hospitalization.

IgE-mediated anaphylaxis induced by Macrogol 6000

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