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An analysis of characteristics of patients with exacerbation of asthma in a large university hospital in Japan.

K. Sugiyama,I. Yamada,Tetsuya Ohara,M. Tatewaki,Yumeko Hayashi,R. Arai,K. Kamiya,F. Fukushima,H. Hirata,M. Arima,Y. Fukushima,T. Fukuda

Published 2010 in Asian Pacific Journal of Allergy and Immunology

ABSTRACT

BACKGROUND Considerable progress has been made in the management of asthma with the increasing use of inhaled corticosteroids. However, asthma exacerbation remains a problem. To analyze the characteristics of patients with exacerbation of asthma who visited our hospital in order to better understand the risk factors for fatal asthma. OBJECTIVES We studied 100 patients who presented at Dokkyo Medical University Hospital (DMUH) with asthma exacerbation. METHODS Entry sheets were completed by physicians and questionnaires by patients. RESULTS Before the exacerbation, the severity was assessed as Step 1 in 46% of patients, Step 2 in 15%, Step 3 in 11%, and Step 4 in 18%. With regard to primary care physicians, 45% were treated at DMUH and 36% had no primary care physicians. Among the DMUH group, the largest proportion was aged 60-69 years and was in Step 4 category. According to asthma control test (ACT) scores, disease was poorly controlled in 83%. Patients with no primary care physician were most often aged 20-39 years (p < 0.01), and severity was assessed as Step 1 in 86% (p < 0.01). However, 44% were poorly controlled according to ACT (p < 0.05). CONCLUSION Patients could be classified into two groups: older patients with severe intractable asthma, treated by a specialist and younger patients considered to have mild asthma, half of whom had poorly controlled asthma and no primary care physician. Systems are needed that allow the emergency physicians to evaluate the need for regular treatment in patients with exacerbation because such patients often visit the hospital at night or on a non-working day.

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