Risk of exacerbation and mortality in asthma – a 10-year retrospective financial database analysis

<bold>Background:</bold> Asthma is the most prevalent obstructive pulmonary disease. Acute severe exacerbations (SAEs) can affect all asthmatics, however data on the risk of exacerbations and mortality after an initial SAE is scarce. <bold>Aims:</bold> Our goal was to assess the risk of severe future asthma flare-ups and mortality in patients who suffered an SAE. <bold>Methods:</bold> The financial database of the Hungarian National Health Insurance Fund (NHIF) was used to. retrospectively analyse the data of all asthmatic patients, who had been hospitalised for a severe exacerbation between 2009 and 2019. A competing risk model was used to assess the risk of subsequents SAEs and death after the first ever SAE. <bold>Results:</bold> Altogether 9,257 patients were enrolled, who had been treated with asthma and had suffered an SAE between 2009-’19. Their average age was 59,24 years, 75.8% were female. Their average Charlson score was 2.25. 3,492 patients suffered at least one subsequent SAE and 1,193 patients died during follow-up. In the competing risk model for exacerbations, there was a statistically significant increase in risk of further SAEs after each SAE (HR=2.013 – 7.026 from the second to the 9th SAE). However, there was no significant increase in the risk for mortality after each subsequent SAE. Fermale patients had a significantly lower risk of death, while older patients and patients with a higher Charlson index score had a significantly higher risk of mortality. <bold>Conclusions:</bold> We concluded that each SAE significantly increased the risk of further SAEs but not death. These findings highlight the importance of thorough management of asthma patients who are at risk of exacerbations.