title: Moderate symptom-based exacerbations as predictors of severe claims-based exacerbations in asthma.
abstract: OBJECTIVE
  Asthma exacerbations have well-established clinical and economic impact, yet lack consensus on characterization of an episode's severity. Asthma treatment guidelines outline the concept of a moderate asthma exacerbation; however, a clear definition that can be operationalized has not been proposed,
  
  
  METHODS
  Adult asthma (ICD-9: 493.XX) patients, with at least 9 months of continuous enrolment in the Fallon Community Health Plan were included in the retrospective cohort study. Patients diagnosed with Chronic Obstructive Pulmonary Disease (COPD) or other lower respiratory tract conditions were excluded. The first reported asthma-related event following a 2-week symptom-free period was designated as the index event. Asthma-related events were categorized as (1) moderate exacerbations (symptom-based) or (2) severe exacerbations (claims-based). Timing between and temporal sequence of asthma-related events along with average costs were calculated,
  
  
  RESULTS
  Of 3126 eligible patients, 55% reported an asthma-related event followed by a recurrent event(s). Moderate exacerbations followed by recurrent moderate exacerbations were most frequent (20%) with the shortest interval between exacerbations (mean: 83 days [SD 87]). Moderate exacerbations followed by severe exacerbations occurred in 16% of patients with an average of 176.74 (SD 176.94) days between events,
  
  
  CONCLUSIONS
  Patient report of asthma bothersome enough to initiate contact with a clinician, but not requiring oral corticosteroid (OCS), is a definition for a moderate exacerbation that can be operationalized for research purposes. Further work is needed to demonstrate whether identification of moderate exacerbations will allow interventions that impact the frequency and timing of future exacerbations.
authors.affiliation: Department of Nutrition and Health Care Management, College of Health Sciences, Appalachian State University, Boone, NC 28608, USA. lanesj1@appstate.edu
authors.forename: Sandi J
authors.initials: SJ
authors.lastname: Lane
authors.forename: Hans
authors.initials: H
authors.lastname: Petersen
authors.forename: James M
authors.initials: JM
authors.lastname: Seltzer
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Blanchette
authors.forename: Prakash
authors.initials: P
authors.lastname: Navaratnam
authors.forename: Felicia
authors.initials: F
authors.lastname: Allen-Ramey
authors.forename: Anne
authors.initials: A
authors.lastname: Fuhlbrigge
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000191:economics / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D018927:Anti-Asthmatic Agents / Q000191:economics / Q000627:therapeutic use; D001249:Asthma / Q000188:drug therapy / Q000191:economics / Q000503:physiopathology*; D015331:Cohort Studies; D003365:Costs and Cost Analysis; D004636:Emergency Service, Hospital / Q000191:economics; D005260:Female; D006760:Hospitalization / Q000191:economics; D006801:Humans; D007345:Insurance Claim Review; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012189:Retrospective Studies; D012720:Severity of Illness Index; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents