
People who have mild asthma and experience occasional acute exacerbations may be victims of their own circumstances. That’s according to a new study from Kaiser Permanente Southern California.
The study, “Risk Factors for Acute Asthma Exacerbations in Adults With Mild Asthma,” was published in The Journal of Allergy and Clinical Immunology: In Practice. Results suggest that a person’s demographics, lifestyle, comorbidities and health care use were likely to blame for the onset of exacerbations, even in patients with mild asthma.
The retrospective cohort study used administrative data from a large managed care organization to identify 199,010 adults, aged 18 to 85 years, who met study criteria for mild asthma between 2013 and 2018. An asthma-coded qualifying visit (index visit) was identified for each patient. Researchers used information at the index visit or from the previous year’s index visit to measure potential risk factors for acute asthma exacerbations (AAEs) in the subsequent year. An AAE was defined as either an asthma-coded hospitalization or emergency department visit, or an asthma-related systemic corticosteroid administration (intramuscular or intravenous) or oral corticosteroid dispensing.
Additionally, the cohort included patients who were current smokers (5.3%), patients who were overweight (30.3%) or obese (44.1%) and patients who exercised at least one day a week (55.8%).
Results indicated that 6.5% of those studied had AAEs within one year after the index visit. Researchers also determined that age, gender, race, ethnicity, smoking status, body mass index, prior acute asthma care and a variety of comorbidities and other clinical characteristics were significant predictors for future AAE risk.
Lead author Wansu Chen, PhD, MD, clinical informatics scientist in the department of research and evaluation at Kaiser Permanente Southern California, wrote that identifying the risk factors for these visits among these patients may guide them toward appropriate preventive therapy.
Further study details include:
- For every 10 years in age and female gender increased risks for AAEs among patients with mild asthma.
- Patients who identified as Black, Hispanic and Asian/Pacific Islander also experienced increased risks for AAEs.
- Participation in state programs, such as Midi-Cal, smoker status and weight increased the risk for AAEs for people who have mild asthma.
- Comorbidities, including allergic rhinitis, chronic sinusitis and nasal polyps, increased AAE risks.
Researchers also looked at patient asthma history, including:
- ED visits for asthma or wheezing
- Asthma exacerbation
- Allergist asthma visit
- Pulmonologist asthma visit
- One or more urgent care visits for asthma
- One asthma visit not with urgent care
- Two or more asthma visits not with urgent care
Some asthma medications increased the risks for AAEs, including:
- Short-acting beta 2-agonists (SABA)
- Antidepressants
- Antibacterial or antimicrobial agents
- Calcium channel blockers
- Proton pump inhibitors
Researchers did note two protective factors against AAE, including insulin and the common diabetes drug, metformin.
Noting that unfavorable outcomes may follow improper management of mild asthma, the researchers said that good risk management plans require accurate assessments of risk factors, particularly as treatment recommendations for asthma evolve. Also, the researchers recommended expanding population-based disease management strategies to include patients with mild asthma in appropriate preventive therapies to reduce AAEs among these patients.