METHODS: Patients ≥ 18 years old admitted from May 2021 to June 2023 with a primary diagnosis of asthma exacerbation were included. Patients with a secondary diagnosis of asthma exacerbation and those without a confirmed diagnosis were excluded.
RESULTS: A total of 186 patients were analyzed, 63% were female, with a mean age of 49 ± 34 years, mean body mass index (BMI) of 26.4 ± 5 kg/m2, mean immunoglobulin E level of 132 ± 235 IU/mL (range: 25-2041), mean eosinophils count of 180 ± 443, and length of stay of 8.6 ± 5 days. Comparing patients with one admission to those with multiple admissions, differences were observed in age (39 ± 15 vs. 58 ± 20, p < 0.0001), BMI (25.2 ± 3 vs. 27.4 ± 4, p < 0.0003), comorbidity (15% vs. 60%, p < 0.0001), and length of stay (4.5 ± 2 vs. 11 ± 3, p < 0.0001). Of the patients, 15% had undiagnosed asthma, 28% had known asthma without maintenance therapy, 23% were managed by primary care, and 34% were followed by pneumology. The mean Test of Adherence to Inhalers (TAI) score was 42.5 ± 8 points, with 70% showing erratic non-adherence, 46% showing deliberate non-adherence, and 21% showing unconscious non-adherence.
CONCLUSIONS: The young population represents a significant percentage of admissions for asthma exacerbation due to poor follow-up in pulmonology clinics, inadequate treatment optimization, and low adherence. This study adds that it is necessary to improve the approach to asthma in primary care to optimize treatment, reduce under-diagnosis, and avoid hospital admissions.
方法:纳入2021年5月至2023年6月主要诊断为哮喘加重的≥18岁患者。二次诊断为哮喘加重的患者和未确诊的患者被排除在外。
结果:共分析了186例患者,63%是女性,平均年龄为49±34岁,平均体重指数(BMI)为26.4±5kg/m2,平均免疫球蛋白E水平为132±235IU/mL(范围:25-2041),平均嗜酸性粒细胞计数为180±443,住院时间为8.6±5天。将一次入院的患者与多次入院的患者进行比较,观察到年龄差异(39±15vs.58±20,p<0.0001),BMI(25.2±3vs.27.4±4,p<0.0003),合并症(15%与60%,p<0.0001),和停留时间(4.5±2vs.11±3,p<0.0001)。在患者中,15%的人患有未确诊的哮喘,28%的人已知哮喘没有维持治疗,23%由初级保健管理,34%其次是肺炎。坚持吸入器的平均测试(TAI)评分为42.5±8分,70%的人表现出反复无常的不坚持,46%的人表现出故意不坚持,21%的人表现出无意识的不依从。
结论:由于肺科诊所的随访不佳,年轻人群占哮喘急性发作患者的很大比例。治疗优化不足,低坚持。这项研究补充说,有必要改善初级保健中的哮喘治疗方法,以优化治疗,减少诊断不足,避免入院。