Original Articles
Rate and Characteristics of Asthma Exacerbations: The ASMAB I Study
Ferran Morella,
, Teresa Genoverb, Xavier Muñoza, Judith García-Aymerichc, Jaume Ferrera, María-Jesús Cruzc
Corresponding author
fmorell@vhebron.net
Correspondence: Dr F. Morell Servei de Pneumologia, Hospital Universitari Vall d'Hebron Pg Vall d'Hebron, 119-12908035 Barcelona, Spain
Correspondence: Dr F. Morell Servei de Pneumologia, Hospital Universitari Vall d'Hebron Pg Vall d'Hebron, 119-12908035 Barcelona, Spain
a Servei de Pneumologia, Hospital Universitari Vall d'Hebron, Barcelona, CIBERES CB 06/036, Instituto de Salud Carlos III, Madrid, Spain
b Departament de Medicina, Universitat Autònoma de Barcelona, Centre d'Assistència Primària Sant Rafael, Barcelona, Spain
c Unitat d'Investigació Respiratòria i Ambiental, Institut Municipal d'Investigació Mèdica (IMIM), CIBER 06/030, Barcelona, Spain
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Ferrer, María-Jesús Cruz" "autores" => array:6 [ 0 => array:4 [ "nombre" => "Ferran" "apellidos" => "Morell" "email" => array:1 [ 0 => "fmorell@vhebron.net" ] "referencia" => array:2 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] 1 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">*</span>" "identificador" => "cor1" ] ] ] 1 => array:3 [ "nombre" => "Teresa" "apellidos" => "Genover" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff2" ] ] ] 2 => array:3 [ "nombre" => "Xavier" "apellidos" => "Muñoz" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff1" ] ] ] 3 => array:3 [ "nombre" => "Judith" "apellidos" => "García-Aymerich" "referencia" => array:1 [ 0 => array:2 [ "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] ] 4 => array:3 [ "nombre" => "Jaume" 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Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff3" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor1" "etiqueta" => "*" "correspondencia" => "Correspondence: Dr F. Morell Servei de Pneumologia, Hospital Universitari Vall d'Hebron Pg Vall d'Hebron, 119-12908035 Barcelona, Spain" ] ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2007-06-18" "PalabrasClave" => array:2 [ "en" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Key words" "identificador" => "xpalclavsec155273" "palabras" => array:7 [ 0 => "Asthma exacerbation" 1 => "Severe asthma exacerbation" 2 => "Readmission" 3 => "Comorbidity" 4 => "Emergency services" 5 => "Hospital admission" 6 => "Epidemiology" ] ] ] "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec155272" "palabras" => array:7 [ 0 => "Agudizaciones asmáticas" 1 => "Agudización grave delasma" 2 => "Readmisiones por asma" 3 => "Ingresos por asma y comorbilidad" 4 => "Servicios de urgencias" 5 => "Hospitalización por asma" 6 => "Epidemiologíadel asma" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objective</span><p class="elsevierStyleSimplePara elsevierViewall">The aim of this study was to determine theincidence and clinical characteristics of asthma exacerbationsseen by emergency services in Barcelona, Spain (the ASMAB-I study).</p> <span class="elsevierStyleSectionTitle">Patients and Methods</span><p class="elsevierStyleSimplePara elsevierViewall">The emergency services consideredin the study served a population of 1 203 598 inhabitants agedover 14 years. Episodes treated in hospital emergencydepartments and by emergency services called to patients'homes over a period of 129 days were included in the study.</p> <span class="elsevierStyleSectionTitle">Results</span><p class="elsevierStyleSimplePara elsevierViewall">In total, 831 episodes of exacerbation wereidentified; 523 were seen in 3 university hospitals, 113 insecondary hospitals, and 195 by emergency services at thepatient's home. Twenty of the patients seen at home weresubsequently taken to hospital. The mean frequency was 6.4 episodes per day, corresponding to a daily incidence of0.53 exacerbations per 100 000 inhabitants (95% confidenceinterval, 0.46-0.56 exacerbations/100 000 inhabitants) and 8.2 per 100 000 asthmatic patients (95% confidence interval,6.89-8.41 exacerbations/100 000 asthmatic patients). Of the276 episodes treated between Monday and Thursday inuniversity hospitals, 66 patients (24%) reported acute onsetand 14 (5%) sudden onset. Only 85 patients (31%) regularlyused inhaled corticosteroids and only 33 (12%) added oralcorticosteroids in the 12 hours prior to consulting emergencyservices. In 16% of cases the episode was classified as severeand in 3% near fatal. Eighty-two patients (30%) were ultimatelyadmitted to hospital: 12% of mild exacerbations, 39% ofmoderate exacerbations, 62% of severe episodes, and 100%of near-fatal episodes. The Charlson comorbidity index washigher in patients admitted to hospital (<span class="elsevierStyleItalic">P</span><.001). In the 28 patients readmitted to hospital (10%), antibiotics (<span class="elsevierStyleItalic">P</span><.001)and ipratropium bromide (<span class="elsevierStyleItalic">P</span><.0001) had been prescribed lessoften at the time of discharge after the first hospital admission.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p class="elsevierStyleSimplePara elsevierViewall">The rate of asthma exacerbation establishedin this study may be a useful indicator of the degree of controlof the disease and may serve as a reference to confirm futureshort-term or lasting increases in asthma exacerbation. Rapidonset (acute or sudden) is common and many patients are notreceiving appropriate treatment prior to hospital admission. Severe exacerbation is common in our practice setting. Hospitaladmission is related to severity and comorbidity. Patients whoare readmitted to hospital had less often received antibiotictreatment and ipratropium bromide when dischargedpreviously.</p>" ] "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Objetivo</span><p class="elsevierStyleSimplePara elsevierViewall">El presente estudio examina la incidencia y lascaracterísticas clínicas de los episodios de agudización as-mática (AA) atendidos en los servicios de urgencias (SU) dela ciudad de Barcelona (estudio ASMAB-I).</p> <span class="elsevierStyleSectionTitle">Pacientes Y Métodos</span><p class="elsevierStyleSimplePara elsevierViewall">Se estudiaron los episodios de AAatendidos en los SU hospitalarios y en el SU domiciliario(061) durante 129 días, correspondientes a una poblaciónmayor de 14 años de 1.203.598 habitantes.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p class="elsevierStyleSimplePara elsevierViewall">Se identificaron 831 episodios de AA, de losque 523 fueron atendidos en 3 hospitales universitarios, 113 en2 hospitales de segundo nivel y otros 195 (de los que 20 se remi-tieron a hospitales) en los SU domiciliarios. La frecuentaciónmedia fue de 6,4 episodios/día, con una incidencia de AA de0,53/105 habitantes/día (intervalo de confianza del 95%, 0,46-0,56) y de 8,2/105 pacientes asmáticos (intervalo de confianzadel 95%, 6,89-8,41). De los 276 episodios atendidos de lunes ajueves en los servicios de los hospitales universitarios, 66 pa-cientes (24%) reconocieron un inicio agudo y 14 (5%) un iniciosúbito. Únicamente 85 pacientes (31%) tomaban de modo re-gular corticoides inhalados y sólo 33 (12%) añadieron corticoi-des orales en las 12 h previas a su llegada a urgencias. Un 16%de los episodios se calificaron de graves y un 3% de casi fatales. Un total de 82 pacientes (30%) fueron finalmente hospitaliza-dos; ingresaron el 12% de las AA leves, el 39% de las AA mo-deradas, el 62% de las AA graves y el 100% de las casi fatales. El índice de comorbilidad de Charlson fue mayor en los pa-cientes hospitalizados (p < 0,001). En los 28 readmitidos (10%), al darles el alta previa se les habían prescrito menos antibióti-cos (p < 0,001) y bromuro de ipratropio (p < 0,0001).</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p class="elsevierStyleSimplePara elsevierViewall">La tasa de AA establecida puede ser unindicador útil del grado de control del asma y servir paraconfirmar futuros aumentos de AA permanentes o puntua-les. El inicio rápido (agudo o súbito) es frecuente. Muchos pacientes no reciben un tratamiento adecuado antes de lahospitalización. La agudización grave es frecuente en nues-tro medio. El ingreso está relacionado con la gravedad y lacomorbilidad. Los readmitidos han recibido al alta menosantibióticos y bromuro de ipratropio.</p>" ] ] "NotaPie" => array:1 [ 0 => array:1 [ "nota" => "<p class="elsevierStyleNotepara">This study was partly funded by a grant from the Catalan Pneumology Foundation (Fundació Catalana de Pneumologia, FUCAP), grants CIBERES CB06/036 and CIBERESP CB 06/030, Carlos III Health Institute, Madrid, and agrant from the Jordi Gol Institute for Research in Primary Care (Institutd'Investigació en Atenció Primària Jordi Gol).</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:42 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Variations in the prevalence of respiratory symptoms, self-reported asthma attacks and use asthma medication in the European Community Respiratory Health Survey" "autores" => array:1 [ 0 => array:2 [ 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 3 | 3 | 6 |
| 2024 October | 33 | 14 | 47 |
| 2024 September | 29 | 16 | 45 |
| 2024 August | 47 | 32 | 79 |
| 2024 July | 23 | 27 | 50 |
| 2024 June | 41 | 35 | 76 |
| 2024 May | 52 | 37 | 89 |
| 2024 April | 18 | 22 | 40 |
| 2024 March | 21 | 16 | 37 |
| 2024 February | 17 | 17 | 34 |
| 2023 March | 2 | 2 | 4 |
| 2023 February | 16 | 17 | 33 |
| 2023 January | 13 | 34 | 47 |
| 2022 December | 19 | 19 | 38 |
| 2022 November | 16 | 16 | 32 |
| 2022 October | 25 | 43 | 68 |
| 2022 September | 11 | 14 | 25 |
| 2022 August | 18 | 28 | 46 |
| 2022 July | 22 | 44 | 66 |
| 2022 June | 17 | 29 | 46 |
| 2022 May | 19 | 20 | 39 |
| 2022 April | 18 | 29 | 47 |
| 2022 March | 21 | 45 | 66 |
| 2022 February | 22 | 20 | 42 |
| 2022 January | 18 | 36 | 54 |
| 2021 December | 14 | 51 | 65 |
| 2021 November | 14 | 45 | 59 |
| 2021 October | 13 | 55 | 68 |
| 2021 September | 34 | 61 | 95 |
| 2021 August | 13 | 32 | 45 |
| 2021 July | 51 | 20 | 71 |
| 2021 June | 20 | 34 | 54 |
| 2021 May | 9 | 25 | 34 |
| 2021 April | 19 | 46 | 65 |
| 2021 March | 22 | 23 | 45 |
| 2021 February | 14 | 17 | 31 |
| 2021 January | 8 | 7 | 15 |
| 2020 December | 14 | 14 | 28 |
| 2020 November | 13 | 15 | 28 |
| 2020 October | 11 | 7 | 18 |
| 2020 September | 9 | 6 | 15 |
| 2020 August | 12 | 12 | 24 |
| 2020 July | 15 | 14 | 29 |
| 2020 June | 17 | 3 | 20 |
| 2020 May | 16 | 17 | 33 |
| 2020 April | 22 | 22 | 44 |
| 2020 March | 21 | 15 | 36 |
| 2020 February | 25 | 15 | 40 |
| 2020 January | 24 | 15 | 39 |
| 2019 December | 44 | 19 | 63 |
| 2019 November | 14 | 9 | 23 |
| 2019 October | 5 | 5 | 10 |
| 2019 September | 7 | 5 | 12 |
| 2019 August | 17 | 11 | 28 |
| 2019 July | 11 | 11 | 22 |
| 2019 June | 4 | 6 | 10 |
| 2019 May | 11 | 8 | 19 |
| 2019 April | 16 | 8 | 24 |
| 2019 March | 10 | 12 | 22 |
| 2019 February | 7 | 12 | 19 |
| 2019 January | 3 | 3 | 6 |
| 2018 December | 4 | 12 | 16 |
| 2018 November | 13 | 12 | 25 |
| 2018 October | 14 | 11 | 25 |
| 2018 September | 17 | 10 | 27 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 9 | 8 | 17 |
| 2018 March | 8 | 2 | 10 |
| 2018 February | 7 | 3 | 10 |
| 2018 January | 5 | 8 | 13 |
| 2017 December | 5 | 4 | 9 |
| 2017 November | 2 | 6 | 8 |
| 2017 October | 10 | 10 | 20 |
| 2017 September | 7 | 9 | 16 |
| 2017 August | 12 | 17 | 29 |
| 2017 July | 12 | 19 | 31 |
| 2017 June | 11 | 9 | 20 |
| 2017 May | 5 | 3 | 8 |
| 2017 April | 3 | 4 | 7 |
| 2017 March | 3 | 5 | 8 |
| 2017 February | 4 | 5 | 9 |
| 2017 January | 1 | 2 | 3 |
| 2016 December | 9 | 5 | 14 |
| 2016 November | 12 | 9 | 21 |
| 2016 October | 14 | 10 | 24 |
| 2016 September | 13 | 11 | 24 |
| 2016 August | 18 | 4 | 22 |
| 2016 July | 12 | 4 | 16 |
| 2016 March | 2 | 0 | 2 |
| 2015 December | 2 | 0 | 2 |
| 2015 October | 52 | 9 | 61 |
| 2015 September | 51 | 8 | 59 |
| 2015 August | 51 | 10 | 61 |
| 2015 July | 50 | 10 | 60 |
| 2015 June | 38 | 3 | 41 |
| 2015 May | 56 | 12 | 68 |
| 2015 April | 39 | 9 | 48 |
| 2015 March | 48 | 6 | 54 |
| 2015 February | 43 | 5 | 48 |
| 2015 January | 39 | 11 | 50 |
| 2014 December | 39 | 8 | 47 |
| 2014 November | 40 | 8 | 48 |
| 2014 October | 68 | 13 | 81 |
| 2014 September | 37 | 10 | 47 |
| 2014 August | 45 | 13 | 58 |
| 2014 July | 47 | 10 | 57 |
| 2014 June | 54 | 13 | 67 |
| 2014 May | 39 | 11 | 50 |
| 2014 April | 56 | 10 | 66 |
| 2014 March | 47 | 15 | 62 |
| 2014 February | 47 | 11 | 58 |
| 2014 January | 35 | 8 | 43 |
| 2013 December | 40 | 13 | 53 |
| 2013 November | 21 | 6 | 27 |
| 2013 October | 21 | 10 | 31 |
| 2013 September | 30 | 11 | 41 |
| 2013 August | 22 | 5 | 27 |
| 2013 July | 43 | 9 | 52 |
| 2013 June | 27 | 7 | 34 |
| 2013 May | 32 | 9 | 41 |
| 2013 April | 15 | 2 | 17 |
| 2013 March | 6 | 2 | 8 |
Show all
