Clinical outcomes after recovery from severe asthma exacerbation: the third report

Inseon S. Choi; Jeong-Nam Eun; Ji-Yun Hong; Myeong-Soo Park

doi:10.4168/aard.2016.4.5.340

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Choi, Eun, Hong, and Park: Clinical outcomes after recovery from severe asthma exacerbation: the third report

Original Article

Allergy, Asthma & Respiratory Disease 2016; 4(5): 340-345.

Published online: 30 September 2016

DOI: https://doi.org/10.4168/aard.2016.4.5.340

Clinical outcomes after recovery from severe asthma exacerbation: the third report

Inseon S. Choi^1,²

, Jeong-Nam Eun², Ji-Yun Hong², Myeong-Soo Park²

¹Department of Allergy, Chonnam National University Medical School, Gwangju, Korea.

²Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Korea.

Correspondence to: Inseon S. Choi. Department of Internal Medicine, Chonnam National University Hospital, 42 Jebong-ro, Dong-gu, Gwangju 61469, Korea. Tel: +82-62-220-6571, Fax: +82-62-225-8578, ischoi@chonnam.ac.kr

Received 10 June 2016 Revised 8 August 2016 Accepted 8 August 2016

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/).

Abstract

Purpose

Up to 10% of the mortality rate of asthmatics within a year from the near-fatal attacks has been reported. We previously reported that not a few patients with acute severe asthma died after discharge from the hospital. This study investigated whether our efforts to improve clinical outcomes of patients after recovery from severe asthma exacerbation did work or not.

Methods

Follow-up data from asthmatic patients who had been hospitalized due to severe exacerbation between 2007 and 2014 (present) were compared with that the previous one (1998–2006) (previous).

Results

Sex, age, near-fatal asthma, and mortality (9.8% vs. 9.6%) were not significantly different between the previous (n=225) and present (n=397) studies. However, rehospitalization rate was significantly lower in the present study (29.3% vs. 52.4%, P=0.000). The patients in the present study used inhaled steroid more frequently (78.5% vs. 68.0%, P=0.006), had better asthma knowledge (P=0.000), and higher proportion of regular hospital visitors to total subjects (75.6% vs. 64.9%, P=0.004) than did the previous patients. The regular hospital visitors (n=300) showed a significantly lower mortality (3.3% vs. 28.9%, P=0.000), better knowledge (P=0.000) and higher inhaled steroid use (85.8% vs. 54.1%, P=0.000) than did the other group (n=97) in the present study.

Conclusion

Clinical outcomes after recovery from severe asthma exacerbation in the present study were better than the previous one. Our efforts to educate patients might contribute to these better results.

Keywords: Asthma, Exacerbation, Mortality, Outcome

Figures and Tables

Fig. 1

Posthospitalization mortality rates in patients with acute severe asthma who did or did not visit regularly an outpatient department (OPD) during follow-up.

Table 1

Clinical characteristics of patients recovered from acute severe asthma.

Characteristic	Previous (1998-2006)	Present (2007-2014)	P-value
No. of subjects	225	397
Male sex	131 (58.2)	215 (54.2)	0.327
Age (yr)	63.1 ± 1.0	62.4 ± 0.9	0.619
Smoker	103 (45.8)	122 (32.9)	0.002
Asthma duration (yr)	9.2 ± 0.8	10.0 ± 0.6	0.403
Near-fatal asthma	44 (19.6)	48 (15.3)	0.200
FEV₁ (%) at discharge	58.3 ± 1.5	54.1 ± 1.5	0.046
Follow-up duration (wk)	139 ± 6	161 ± 6	0.010
Regular OPD visitor	146 (64.9)	300 (75.6)	0.004
Mortality	22 (9.8)	38 (9.6)	0.933
Rehospitalization	118 (52.4)	83 (29.3)	0.000
Inhaled steroid use	153 (68.0)	252 (78.5)	0.006
Asthma knowledge	9.3 ± 0.2	10.4 ± 0.2	0.000

Values are presented as number (%) or mean±standard deviation.

FEV₁, forced expiratory volume in 1 second, expressed as % of predicted; OPD, out-patient department.

Table 2

Comparisons between regular and nonregular out-patient department visitors

Variable	Previous (1998-2006)		Present (2007-2014)
Variable	Regular OPD visitor	Nonregular OPD visitor	Regular OPD visitor	Nonregular OPD visitor
Total
No. of subjects	146 (64.9)	79 (35.1)	300 (75.6)	97 (24.4)
Male sex	86 (58.9)	45 (57.0)	164 (54.7)	51 (52.6)
Age (yr)	62.7±1.2	63.7±1.7	63.1±0.9	60.3±2.0
Smoker	71 (48.6)	32 (40.5)	89 (31.2)^†	27 (31.4)
Near-fatal asthma	29 (19.9)	15 (19.0)	38 (15.6)	10 (14.3)
Follow-up duration (wk)	140±8	138±9	173±6^*†	95±13^†
Mortality	9 (6.2)^*	13 (16.5)	10 (3.3)^*	28 (28.9)
Rehospitalization	94 (64.4)^*	24 (30.4)	72 (31.6)^†	11 (20.0)
Inhaled steroid use	109 (74.7)^*	44 (55.7)	212 (85.8)^*†	40 (54.1)
Asthma knowledge	9.7±0.2^*	8.5±0.3	10.8±0.2^*†	8.8±0.5
Near-fatal asthma
No. of subjects	29 (65.9)	15 (34.1)	38 (79.2)	10 (20.8)
Male	18 (62.1)	13 (86.7)	20 (52.6)	4 (40.0)^†
Age (yr)	64.7±1.9	59.4±4.2	64.1±1.9	66.3±5.0
Smoker	14 (48.3)	7 (46.7)	13 (36.1)	3 (42.9)
Follow-up duration (wk)	150±18	169±24	207±19^†	175±37
Mortality	1 (3.4)^*	6 (40.0)	4 (10.5)^*	6 (60.0)
Rehospitalization	22 (75.9)^*	4 (26.7)	16 (47.1)^†	1 (16.7)
Inhaled steroid use	23 (79.3)	8 (53.3)	33 (86.8)^*	3 (30.0)
Asthma knowledge	10.0±0.5^*	7.4±0.6	11.0±0.5	8.7±1.2

Values are presented as number (%) or mean±standard deviation.

OPD, out-patient department.

^*P<0.05 compared to nonregular OPD visitor. ^†P<0.05 compared to previous study.

Table 3

Comparisons between male and female patients in the present study

Variable	Regular OPD visitor		Non-regular OPD visitor
Variable	Male	Female	Male	Female
Total
No. of subjects	164 (54.7)	136 (45.3)	51 (52.6)	46 (47.4)
Age (yr)	64.1±1.3	62.0±1.3	58.2±2.9	62.6±2.6
Smoker	73 (46.8)	16 (12.4)^§	22 (47.8)	5 (12.5)^§
Near-fatal asthma	20 (15.4)	18 (15.9)	4 (11.1)	6 (17.6)
Follow-up duration (wk)	175±9^†	170±9^†	94±18	96±18
Mortality	5 (3.0)^†	5 (3.7)^†	13 (25.5)	15 (32.6)
Rehospitalization	39 (30.7)^†	33 (32.7)	2 (7.1)	9 (33.3)^‡
Inhaled steroid use	116 (87.9)^†	96 (83.5)^†	24(63.2)	16 (44.4)
Asthma knowledge	10.8±0.2^†	10.7±0.4^*	8.6±0.7	9.0±0.6
Near-fatal asthma
No. of subjects	20 (52.6)	18 (47.4)	4 (40.0)	6 (60.0)
Age (yr)	61.9±2.8	66.5±2.3	74.3±3.5	61.0±7.6
Smoker	10 (52.6)	3 (17.6)^‡	2 (66.7)	1 (25.0)
Follow-up duration (wk)	219±26	195±28	-	175±37
Mortality	2 (10.0)^†	2 (11.1)	4 (100)	2 (33.3)
Rehospitalization	7 (38.9)	9 (56.3)	0 (0%)	1 (25.0)
Inhaled steroid use	17 (85.0)^*	16 (88.9)^*	1 (25.0)	2 (33.3)
Asthma knowledge	10.3±0.7	12.3±0.4^†‡	-	8.7±1.2

Values are presented as number (%) or mean±standard deviation.

OPD, out-patient department.

^*P<0.05. ^†P<0.01 compared to corresponding nonregular OPD visitor. ^‡P<0.05. ^§P<0.01 compared to male.

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ORCID iDs: Inseon S. Choi
https://orcid.org/http://orcid.org/0000-0002-5038-4722
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