One Year of Real-Life Practice in Treatment Strategies and Future Exacerbation among Asthma Patients with Exacerbation Required Emergency Department Visits

Objective: To investigate the treatment patterns and clinical outcomes regarding future exacerbation in patients with a history of emergency department (ED) visited exacerbation.Material and Methods: We analyzed the treatment patterns and moderate/severe asthma exacerbation rates over a year. The Kaplan-Meier method was used to determine the probability of an asthma exacerbation, and the time to the first exacerbation was compared.Results: Of the 155 patients, 59 (38.1%) had naïve treatment, 53 (34.2%) and 43 (27.7%) received GINA-classified steps 1-2 and 3-5 treatments, respectively. Approximately 50% of those with naïve treatment lost adherence after a year of follow-up. However, the annual moderate/severe exacerbation rate was reported as the lowest and increased from 0.34 to 0.49 (p-value=0.236) compared to those with steps 1-2 and 3-5 treatments, from 0.66 to 0.47 (p-value=0.085) and 3.00 to 1.19 (p-value=0.006), respectively. Patients with GINA-classified steps 3-5 treatment were prescribed controllers 10.9 more than the 7.8 canisters prescribed to those with naïve treatment (p-value<0.001). In contrast, there were no differences in total reliever prescriptions between the groups (p-value=0.274). Finally, there was no significant difference in the likelihood of having future exacerbations (p-value=0.107). The estimated time of exacerbation in naïve treatment, GINA-classified steps 1-2, and 3-5 treatment were 42.2, 36.6, and 34.2 weeks, respectively.Conclusion: This study confirms that the frequency of future exacerbations following an ED-visited exacerbation increases as the stepwise treatment increases. This finding may help clinicians understand the natural history of treatment patterns and exacerbation outcomes. Patients with naïve treatment may have a unique history of significantly less exacerbation despite discontinuing controllers.