Imperial College London
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DrJohannaFeary

Faculty of Medicine, National Heart & Lung Institute

Senior Clinical Research Fellow
 
 
 
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Contact

 

+44 (0)20 7594 7968j.feary

 
 
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Location

 

G46Emmanuel Kaye BuildingRoyal Brompton Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bloom:2018:10.1164/rccm.201808-1516OC,
author = {Bloom, CI and Palmer, T and Feary, J and Quint, JK and Cullinan, P},
doi = {10.1164/rccm.201808-1516OC},
journal = {American Journal of Respiratory and Critical Care Medicine},
pages = {446--453},
title = {Exacerbation patterns in adults with asthma in England: A population based study},
url = {http://dx.doi.org/10.1164/rccm.201808-1516OC},
volume = {199},
year = {2018}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - Rationale Asthma is heterogeneous and knowledge on exacerbation patterns is lacking. Previous studies have had a relatively short follow-up or focused on severe disease. Objectives Describe exacerbation patterns over a prolonged follow-up in a population including patients of all disease severity. Methods We used electronic healthcare records to identify asthma patients aged 18-55 years and their exacerbations, 2007-2015. A cohort with ≥7-years of data was used to describe exacerbation patterns by asthma severity defined by medication use. Effect estimates for risk factors were calculated for sporadic (single year of exacerbations) and recurrent (>1 year) exacerbation patterns, using logistic regression. In a nested case-control design, the association between a history of exacerbations, spanning 5-years, and a future exacerbation was examined. Measurements and Main Results 51,462 patients were eligible for the 7-year cohort; 64% had no exacerbations. Of those who exacerbated, 51% did so only once; exacerbation frequency increased with disease severity. Only 370 patients (0.7%) were characterised by a frequent-exacerbator phenotype (yearly exacerbations), of whom 58% had mild/moderate asthma. Exacerbation risk factors were not uniquely associated with a particular exacerbation pattern. A past exacerbation increased the risk of a future exacerbation more than all other factors, although this effect dissipated over 5-years. Conclusions During 7-years of follow-up, exacerbations occur in around one-third of patients. Of those who exacerbate, half do not do so again; the timing of future exacerbations is largely unpredictable. Just 2% exhibit a frequent-exacerbator phenotype. Past exacerbation patterns are the most informative risk factor for predicting future exacerbations.
AU  - Bloom,CI
AU  - Palmer,T
AU  - Feary,J
AU  - Quint,JK
AU  - Cullinan,P
DO  - 10.1164/rccm.201808-1516OC
EP  - 453
PY  - 2018///
SN  - 1073-449X
SP  - 446
TI  - Exacerbation patterns in adults with asthma in England: A population based study
T2  - American Journal of Respiratory and Critical Care Medicine
UR  - http://dx.doi.org/10.1164/rccm.201808-1516OC
UR  - https://www.ncbi.nlm.nih.gov/pubmed/30507307
UR  - https://www.atsjournals.org/doi/10.1164/rccm.201808-1516OC
UR  - http://hdl.handle.net/10044/1/65171
VL  - 199
ER  -
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