Characterisation Of Patients Hospitalised For Asthma Exacerbations In Hong Kong

Background: Asthma hospitalisation poses a heavy burden on health care. Aims: This retrospective study examined the characteristics of hospitalised patients for asthma exacerbations before the index admission to identify remedial factors for reducing this burden. Methods: Medical records of patients aged >18 years admitted to 11 public hospitals in Hong Kong from 1 January to 31 December 2016 for asthma exacerbations were reviewed manually. Results: There were 3169 admissions from 2295 patients (36.7% males; median[interquartile range] age 66[48–81] years), of whom 518 had ≥2 admissions. In the year prior to the index admission, 46.4% had attended Accident & Emergency department, 38.7% had been hospitalised; 7.1% had required intensive care and 6.0% had been intubated at least once for asthma exacerbations in their lifetime. Only 64.5% of patients were prescribed inhaled corticosteroid (ICS) at the baseline. Even amongst those with ≥2 admissions, 16.7% were not prescribed ICS and only 35.7% had spirometry checked before the last admission. Three of the 19 patients who died of asthma had no controller medication. Cardiovascular, respiratory, neuropsychiatric and metabolic co-morbidities were respectively found in 49.5%, 32.5%, 20.6% and 53.2% of all patients. Of the 1374 patients (59.9%) received ICS plus at least 1 other controller medications, 124(5.4%) and 1201(52.3%) patients had total serum IgE and blood eosinophil count checked. Conclusions: Suboptimal management is common in patients hospitalised for asthma exacerbations prior to their admission. Improving asthma care, especially in patients with a prior history of urgent health care utilisation and co-morbidities, may help reduce health care burden.