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Dhar R, Rhee CK, Perng DW, Fukunaga K, Ip MSM, Juthong S, Koh MS, Li J, Sharma S, Wiyono WH. The burden of systemic corticosteroid use in asthma management in Asia. Respirology 2023. [PMID: 37301540 DOI: 10.1111/resp.14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/03/2023] [Indexed: 06/12/2023]
Abstract
For most patients, asthma can be effectively managed using inhaled medications. However, patients who have severe and/or uncontrolled asthma, or who experience exacerbations, may require systemic corticosteroids (SCSs) to maintain asthma control. Although SCS are highly effective in this regard, even modest exposure to these medications can increase the risk for long-term, adverse health outcomes, such as type 2 diabetes, renal impairment, cardiovascular disease and overall mortality. Clinical and real-world data from studies investigating asthma severity, control and treatment practices around the globe have suggested that SCS are overused in asthma management, adding to the already substantial healthcare burden experienced by patients. Throughout Asia, although data on asthma severity, control and SCS usage are limited and vary widely among countries, available data strongly suggest a pattern of overuse consistent with the broader global trend. Coordinated changes at the patient, provider, institutional and policy levels, such as increasing disease awareness, promoting better adherence to treatment guidelines and increasing availability of safe and effective alternatives to SCS, are likely necessary to reduce the SCS burden for patients with asthma in Asia.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CK Birla Group of Hospitals, Kolkata, West Bengal, India
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, South Korea
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Koichi Fukunaga
- Department of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Siwasak Juthong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jing Li
- Allergy and Clinical Immunology Department, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shubham Sharma
- Heart and Lung Transplant Unit, Yashoda Hospitals, Secunderabad, India
| | - Wiwien Heru Wiyono
- Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
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Ramjith J, Bender A, Roes KCB, Jonker MA. Recurrent events analysis with piece-wise exponential additive mixed models. STAT MODEL 2022. [DOI: 10.1177/1471082x221117612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Recurrent events analysis plays an important role in many applications, including the study of chronic diseases or recurrence of infections. Historically, many models for recurrent events have been variants of the Cox model. In this article we introduce and describe the application of the piece-wise exponential Additive Mixed Model (PAMM) for recurrent events analysis and illustrate how PAMMs can be used to flexibly model the dependencies in recurrent events data. Simulations confirm that PAMMs provide unbiased estimates as well as equivalence to the Cox model when proportional hazards are assumed. Applications to recurrence of staphylococcus aureus and malaria in children illustrate the estimation of seasonality, bivariate non-linear effects, multiple timescales and relaxation of the proportional hazards assumption via time-varying effects. The R package pammtools is extended to facilitate estimation and visualization of PAMMs for recurrent events data.
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Affiliation(s)
- Jordache Ramjith
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | | | - Kit C. B. Roes
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
| | - Marianne A. Jonker
- Department for Health Evidence, Biostatistics Research Group, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, Netherlands
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Chan KP, Ko FWS, Ling KC, Cheung PS, Chan LV, Chan YH, Lo YT, Ng CK, Lui MMS, Yee KSW, Tseng CZS, Tse PY, Wong MLM, Choo KL, Lam WK, Wong CM, Ho SS, Lun CT, Lai CKW. A territory-wide study on the factors associated with recurrent asthma exacerbations requiring hospitalization in Hong Kong. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:569-581. [PMID: 33657275 PMCID: PMC8127557 DOI: 10.1002/iid3.419] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 02/16/2021] [Indexed: 11/30/2022]
Abstract
Background The real‐world relationships between the demographic and clinical characteristics of asthma patients, their prehospitalization management and the frequency of hospitalization due to asthma exacerbation is poorly established. Objective To determine the risk factors of recurrent asthma exacerbations requiring hospitalizations and evaluate the standard of baseline asthma care. Methods A territory‐wide, multicentre retrospective study in Hong Kong was performed. Medical records of patients aged ≥18 years admitted to 11 acute general hospitals from January 1 to December 31, 2016 for asthma exacerbations were reviewed. Results There were 2280 patients with 3154 admissions (36.7% male, median age 66.0 [interquartile range: 48.0–81.0] years, 519 had ≥2 admissions). Among them, 1830 (80.3%) had at least one asthma‐associated comorbidity, 1060 (46.5%) and 885 (38.9%) of patients had Accident and Emergency Department (AED) attendance and hospitalization in the preceding year, respectively. Patients with advancing age (incidence rate ratio [IRR]: 1.003 for every year increment), a history of AED visits or hospitalization (IRR: 1.018 and 1.070 for every additional episode, respectively) for asthma exacerbation in the preceding year, the presence of neuropsychiatric (IRR: 1.142) and gastrointestinal (IRR: 1.154) comorbidities were risk factors for an increasing number of admissions for asthma exacerbation. For patients with ≥2 admissions, 17.1% were not prescribed inhaled corticosteroid and only 44.6% had spirometry checked before the index admission. Asthma phenotyping was often incomplete, as assessment of atopy (total serum immunoglobulin E level and senitization to aeroallergens) was only performed in 30 (5.8%) patients with ≥2 admissions. Conclusions and Clinical Relevance Improving asthma care, especially in elderly patients with a prior history of urgent healthcare utilization and comorbidities, may help reduce healthcare burden. Suboptimal management before the index admission was common in patients hospitalized for asthma exacerbations. Early identification of patients at risk and enhancement of baseline asthma management may help to prevent recurrent asthma exacerbation and subsequent hospitalization.
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Affiliation(s)
- Ka Pang Chan
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Fanny Wai San Ko
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China.,Department of Medicine & Therapeutics, Prince of Wales Hospital, Hong Kong, China
| | - Kwun Cheung Ling
- Department of Medicine & Therapeutics, Chinese University of Hong Kong, Hong Kong, China
| | - Pik Shan Cheung
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Lee Veronica Chan
- Department of Medicine & Geriatrics, United Christian Hospital, Hong Kong, China
| | - Yu Hong Chan
- Department of Medicine & Geriatrics, Princess Margaret Hospital, Hong Kong, China
| | - Yi Tat Lo
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Hong Kong, China
| | - Chun Kong Ng
- Department of Medicine, Queen Elizabeth Hospital, Hong Kong, China
| | - Macy Mei-Sze Lui
- Department of Medicine, The University of Hong Kong, Hong Kong, China.,Department of Medicine, Queen Mary Hospital, Hong Kong, China
| | | | | | - Pak Yiu Tse
- Department of Medicine, Tseung Kwan O Hospital, Hong Kong, China
| | - Mo Lin Maureen Wong
- Department of Medicine & Geriatrics, Caritas Medical Centre, Hong Kong, China
| | - Kah Lin Choo
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Wai Kei Lam
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Chun Man Wong
- Department of Medicine, North District Hospital, Hong Kong, China
| | - Sheng Sheng Ho
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
| | - Chung Tat Lun
- Department of Medicine, Alice Ho Miu Ling Nethersole Hospital, Hong Kong, China
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