Multinational cohort study of mortality in patients with asthma and severe asthma

Marjolein Engelkes; Maria Aj de Ridder; Elisabeth Svensson; Klara Berencsi; Daniel Prieto-Alhambra; Francesco Lapi; Carlo Giaquinto; Gino Picelli; Nada Boudiaf; Frank C Albers; Sarah M Cockle; Eric S Bradford; Robert Y Suruki; Guy Go Brusselle; Peter R Rijnbeek; Miriam Cjm Sturkenboom; Katia Mc Verhamme

doi:10.1016/j.rmed.2020.105919

Multinational cohort study of mortality in patients with asthma and severe asthma

Marjolein Engelkes, Maria Aj de Ridder, Elisabeth Svensson, Klara Berencsi, Daniel Prieto-Alhambra, Francesco Lapi, Carlo Giaquinto, Gino Picelli, Nada Boudiaf, Frank C Albers, Sarah M Cockle, Eric S Bradford, Robert Y Suruki, Guy Go Brusselle, Peter R Rijnbeek, Miriam Cjm Sturkenboom, Katia Mc Verhamme^*

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.

METHODS: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.

RESULTS: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.

CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

Original language	English
Article number	105919
Journal	Respiratory Medicine
Volume	165
DOIs	https://doi.org/10.1016/j.rmed.2020.105919
Publication status	Published - 1 Apr 2020

Keywords

Adrenal Cortex Hormones
Age Factors
Asthma/mortality
Cause of Death
Cohort Studies
Comorbidity
Disease Progression
Drug Utilization
Emergency Service, Hospital/statistics & numerical data
Europe/epidemiology
Female
Hospitalization/statistics & numerical data
Humans
Male
Severity of Illness Index
Sex Factors
Smoking/adverse effects
Mortality
Cohort studies
Asthma epidemiology
Severe asthma

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10.1016/j.rmed.2020.105919

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Engelkes, M., de Ridder, M. A., Svensson, E., Berencsi, K., Prieto-Alhambra, D., Lapi, F., Giaquinto, C., Picelli, G., Boudiaf, N., Albers, F. C., Cockle, S. M., Bradford, E. S., Suruki, R. Y., Brusselle, G. G., Rijnbeek, P. R., Sturkenboom, M. C., & Verhamme, K. M. (2020). Multinational cohort study of mortality in patients with asthma and severe asthma. Respiratory Medicine, 165, Article 105919. https://doi.org/10.1016/j.rmed.2020.105919

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title = "Multinational cohort study of mortality in patients with asthma and severe asthma",

abstract = "BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.METHODS: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.RESULTS: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.",

keywords = "Adrenal Cortex Hormones, Age Factors, Asthma/mortality, Cause of Death, Cohort Studies, Comorbidity, Disease Progression, Drug Utilization, Emergency Service, Hospital/statistics & numerical data, Europe/epidemiology, Female, Hospitalization/statistics & numerical data, Humans, Male, Severity of Illness Index, Sex Factors, Smoking/adverse effects, Mortality, Cohort studies, Asthma epidemiology, Severe asthma",

author = "Marjolein Engelkes and {de Ridder}, {Maria Aj} and Elisabeth Svensson and Klara Berencsi and Daniel Prieto-Alhambra and Francesco Lapi and Carlo Giaquinto and Gino Picelli and Nada Boudiaf and Albers, {Frank C} and Cockle, {Sarah M} and Bradford, {Eric S} and Suruki, {Robert Y} and Brusselle, {Guy Go} and Rijnbeek, {Peter R} and Sturkenboom, {Miriam Cjm} and Verhamme, {Katia Mc}",

note = "Funding Information: DPA has received research grants from Amgen, Bioiberica and GSK and speaker/advisory fees from Amgen and Bioiberica, paid to his department. Funding Information: Funding for this study was provided by GSK ( PRJ2284 ) and ZonMw (ME and KV) ( 113201006 ). Funding Information: MR, PR, MS and KV's institution has received unconditional research grants from Boehringer-Ingelheim, Novartis, Pfizer, Yamanouchi, Servier, and Johnson & Johnson, unrelated to the current manuscript; MR, PR, MS and KV's received an unconditional grant from GSK to conduct research on incidence and risk factors of asthma exacerbations as part of the GSK/EU-ADR alliance. Publisher Copyright: {\textcopyright} Elsevier Ltd",

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doi = "10.1016/j.rmed.2020.105919",

language = "English",

volume = "165",

journal = "Respiratory Medicine",

issn = "0954-6111",

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Engelkes, M, de Ridder, MA, Svensson, E, Berencsi, K, Prieto-Alhambra, D, Lapi, F, Giaquinto, C, Picelli, G, Boudiaf, N, Albers, FC, Cockle, SM, Bradford, ES, Suruki, RY, Brusselle, GG, Rijnbeek, PR, Sturkenboom, MC & Verhamme, KM 2020, 'Multinational cohort study of mortality in patients with asthma and severe asthma', Respiratory Medicine, vol. 165, 105919. https://doi.org/10.1016/j.rmed.2020.105919

TY - JOUR

T1 - Multinational cohort study of mortality in patients with asthma and severe asthma

AU - Engelkes, Marjolein

AU - de Ridder, Maria Aj

AU - Svensson, Elisabeth

AU - Berencsi, Klara

AU - Prieto-Alhambra, Daniel

AU - Lapi, Francesco

AU - Giaquinto, Carlo

AU - Picelli, Gino

AU - Boudiaf, Nada

AU - Albers, Frank C

AU - Cockle, Sarah M

AU - Bradford, Eric S

AU - Suruki, Robert Y

AU - Brusselle, Guy Go

AU - Rijnbeek, Peter R

AU - Sturkenboom, Miriam Cjm

AU - Verhamme, Katia Mc

N1 - Funding Information: DPA has received research grants from Amgen, Bioiberica and GSK and speaker/advisory fees from Amgen and Bioiberica, paid to his department. Funding Information: Funding for this study was provided by GSK ( PRJ2284 ) and ZonMw (ME and KV) ( 113201006 ). Funding Information: MR, PR, MS and KV's institution has received unconditional research grants from Boehringer-Ingelheim, Novartis, Pfizer, Yamanouchi, Servier, and Johnson & Johnson, unrelated to the current manuscript; MR, PR, MS and KV's received an unconditional grant from GSK to conduct research on incidence and risk factors of asthma exacerbations as part of the GSK/EU-ADR alliance. Publisher Copyright: © Elsevier Ltd

PY - 2020/4/1

Y1 - 2020/4/1

N2 - BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.METHODS: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.RESULTS: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

AB - BACKGROUND: Data on the risk of death following an asthma exacerbation are scarce. With this multinational cohort study, we assessed all-cause mortality rates, mortality rates following an exacerbation, and patient characteristics associated with all-cause mortality in asthma.METHODS: Asthma patients aged ≥18 years and with ≥1 year of follow-up were identified in 5 European electronic databases from the Netherlands, Italy, UK, Denmark and Spain during the study period January 1, 2008-December 31, 2013. Patients with asthma-COPD overlap were excluded. Severe asthma was defined as use of high dose ICS + use of a second controller. Severe asthma exacerbations were defined as emergency department visits, hospitalizations or systemic corticosteroid use, all for reason of asthma.RESULTS: The cohort consisted of 586,436 asthma patients of which 42,611 patients (7.3%) had severe asthma. The age and sex standardized all-cause mortality rates ranged between databases from 5.2 to 9.5/1000 person-years (PY) in asthma, and between 11.3 and 14.8/1000 PY in severe asthma. The all-cause mortality rate in the first week following a severe asthma exacerbation ranged between 14.1 and 59.9/1000 PY. Mortality rates remained high in the first month following a severe asthma exacerbation and decreased thereafter. Higher age, male gender, comorbidity, smoking, and previous severe asthma exacerbations were associated with mortality.CONCLUSION: All-cause mortality following a severe exacerbation is high, especially in the first month following the event. Smoking cessation, comorbidity-management and asthma-treatment focusing on the prevention of exacerbations might reduce associated mortality.

KW - Adrenal Cortex Hormones

KW - Age Factors

KW - Asthma/mortality

KW - Cause of Death

KW - Cohort Studies

KW - Comorbidity

KW - Disease Progression

KW - Drug Utilization

KW - Emergency Service, Hospital/statistics & numerical data

KW - Europe/epidemiology

KW - Female

KW - Hospitalization/statistics & numerical data

KW - Humans

KW - Male

KW - Severity of Illness Index

KW - Sex Factors

KW - Smoking/adverse effects

KW - Mortality

KW - Cohort studies

KW - Asthma epidemiology

KW - Severe asthma

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U2 - 10.1016/j.rmed.2020.105919

DO - 10.1016/j.rmed.2020.105919

M3 - Article

C2 - 32174450

SN - 0954-6111

VL - 165

JO - Respiratory Medicine

JF - Respiratory Medicine

M1 - 105919

ER -

Multinational cohort study of mortality in patients with asthma and severe asthma

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Keywords

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