A multicenter retrospective longitudinal study of the status of asthma treatment in Chongqing based on medical big data_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

LIU Xiang ¹ , HU Zhong ² , WANG jin ² , LU Junyu ³ , YUAN Jinhe ³ , LI Juan ⁴ , WANG Gang ⁴ , YU Lin ⁵ , WU Kui ¹ , YAO Wei ¹ ,  SUN Xin ⁵ ,  WANG Changzheng ¹

1. Department of Respiratory Medicine, The Third Affiliated Hospital of Chongqing Medical University, Chongqing 401120, P. R. China;
2. Department of Respiratory and Critical Care Medicine, The First People’s Hospital of Chongqing Liang Jiang New Area, Chongqing 401121, P. R. China;
3. Department of Respiratory and Critical Care Medicine, The Fifth People’s Hospital of Chongqing, Chongqing 400062, P. R. China;
4. Department of Respiratory and Critical Care Medicine, Traditional Chinese Medical Hospital of Chongqing Liang Jiang New Area, Chongqing 401123, P. R. China;
5. Chongqing Nanpeng Artificial Intelligence Technology Research Institute Co., Ltd., Chongqing 401123, P. R. China;

Corresponding author：

SUN Xin, Email: sunxin_0107@163.com; WANG Changzheng, Email: czwang@netease.com

Keywords：

Asthma; Big data; Therapy

DOI：

10.7507/1671-6205.202304053

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Objective To understand the trend and problems of asthma treatment in different levels of hospitals in Chongqing, and to provide objective basis for more refined and standardized asthma management. Methods The outpatient and inpatient asthma diagnosis and treatment data of four hospitals of different grades in Chongqing from 2017 to 2021 were extracted by medical big data capture platform, and the trend of outpatient and prescription changes was analyzed retrospectively according to natural year. Results There were 19514 outpatients asthma visits in the four hospitals, of whom 11816 (60.6%) were female. There were 1875 hospitalizations, of which 1117 (59.6%) were female. ① Changes of asthma visit mode: From 2017 to 2019, the number of outpatient asthma visits and the proportion of asthma in the total outpatient volume increased, decreased significantly in 2021, and basically recovered to the level of 2019 in 2022. Asthma hospitalizations in tertiary hospitals showed a decreasing trend, while those in secondary hospitals increased significantly. The proportion of asthma patients who chose outpatient treatment in the four hospitals increased year by year, among which the increase was more significant in non-tertiary teaching hospitals, and the proportion of asthma acute attack in outpatient and inpatient treatment increased. ② Changes of medication pattern: The rate of inhaled corticosteroids/long-acting β₂-agonists (ICS/LABA) prescription in outpatient department increased year by year, the highest was 48.6%, but the rate of short-acting β₂-agonists (SABA) prescription also increased year by year, especially in secondary hospitals, the rate of SABA prescription in secondary hospitals reached 39.7%. The proportion of hospitalized asthma patients treated with inhaled corticosteroids (85.1%) was higher than that of intravenous corticosteroids (50.9%), and the proportion of intravenous theophylline prescription was as high as 91.7%, while the proportion of nebulized SABA prescription was 71.4%. Conclusions The trend of asthma diagnosis and treatment is that the number of outpatients and the use of ICS/LABA is gradually increasing, while the number of inpatients is decreasing. However, there is still a large gap in the proportion of asthma maintenance medication used in different levels of hospitals, so it is necessary to continuously promote standardized diagnosis and treatment management of asthma in hospitals at all levels, especially primary hospitals.

Citation： LIU Xiang, HU Zhong, WANG jin, LU Junyu, YUAN Jinhe, LI Juan, WANG Gang, YU Lin, WU Kui, YAO Wei, SUN Xin, WANG Changzheng. A multicenter retrospective longitudinal study of the status of asthma treatment in Chongqing based on medical big data. Chinese Journal of Respiratory and Critical Care Medicine, 2023, 22(6): 387-394. doi: 10.7507/1671-6205.202304053 Copy

1.	Huang KW, Yang T, Xu JY, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
2.	Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med, 2004, 170(8): 836-844.
3.	Nathan RA , Thompson PJ, Price D, et al. Taking Aim at Asthma Around the World: Global Results of the Asthma Insight and Management Survey in the Asia-Pacific Region, Latin America, Europe, Canada, and the United States. J Allergy Clin Immunol Pract, 2015, 3(5): 734-742. e5.
4.	林江涛, 王文巧, 周新, 等. 我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化. 中华结核和呼吸杂志, 2018, 41(3): 191-195.
5.	包海荣, 杨洁, 郭超, 等. 甘肃省不同级别医院哮喘患者的控制现状及对疾病认知程度的基线调查. 中国呼吸与危重监护杂志, 2013, 12(5): 446-450.
6.	谢华, 陈萍, 张志远, 等. 施行规范化管理10年单中心住院支气管哮喘患者调查结果分析. 中华结核和呼吸杂志, 2019, 42(3): 179-184.
7.	Janson C, Menzies-Gow A, Nan C, et al. SABINA: an overview of short-acting β₂-agonist use in asthma in European countries. Adv Ther, 2020, 37(3): 1124-1135.
8.	周新. 将中国支气管哮喘防治指南推广普及到基层. 中华结核和呼吸杂志, 2018, 41(3): 161-162.
9.	刘春涛. 我国西部地区支气管哮喘防治的瓶颈和对策. 中华结核和呼吸杂志, 2018, 41(3): 2.
10.	Shelley M , Croft P, Chapman S, et al. Is the quality of asthma prescribing, as measured by the general practice ratio of corticosteroid to bronchodilator, associated with asthma morbidity? J Clin Epidemiol, 2000, 53(12): 1217-1221.
11.	中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
12.	Corrao G, Arfè A, Nicotra F, et al. Persistence with inhaled corticosteroids reduces the risk of exacerbation among adults with asthma: a real-world investigation. Respirology, 2016, 21(6): 1034-1040.
13.	Bateman ED , Price DB, Wang HC, et al. Short-acting β₂-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J, 2022, 59(5): 2101402.
14.	Wang CY, Lai CC, Wang YH, et al. The prevalence and outcome of short-acting β2-agonists overuse in asthma patients in Taiwan. NPJ Prim Care Respir Med, 2021, 31(1): 19.
15.	Bloom CI, Saglani S, Feary J, et al. Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population-based cohort 2006-2016. Eur Respir J, 2019, 53(4): 1802130.
16.	Choi JY, Yoon HK, Lee JH, et al. Nationwide use of inhaled corticosteroids by South Korean asthma patients: an examination of the Health Insurance Review and Service database. J Thorac Dis, 2018, 10(9): 5405-5413.
17.	Suruki RY , Daugherty JB , Boudiaf N , et al. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm Med, 2017, 17(1): 74.
18.	Bleecker ER, Menzies-Gow AN, Price DB, et al. Systematic literature review of systemic corticosteroid use for asthma management. Am J Respir Crit Care Med, 2020, 201(3): 276-293.

1. Huang KW, Yang T, Xu JY, et al. Prevalence, risk factors, and management of asthma in China: a national cross-sectional study. Lancet, 2019, 394(10196): 407-418.
2. Bateman ED, Boushey HA, Bousquet J, et al. Can guideline-defined asthma control be achieved? The Gaining Optimal Asthma ControL study. Am J Respir Crit Care Med, 2004, 170(8): 836-844.
3. Nathan RA , Thompson PJ, Price D, et al. Taking Aim at Asthma Around the World: Global Results of the Asthma Insight and Management Survey in the Asia-Pacific Region, Latin America, Europe, Canada, and the United States. J Allergy Clin Immunol Pract, 2015, 3(5): 734-742. e5.
4. 林江涛, 王文巧, 周新, 等. 我国十城市支气管哮喘控制和疾病管理及患者认知水平的变化. 中华结核和呼吸杂志, 2018, 41(3): 191-195.
5. 包海荣, 杨洁, 郭超, 等. 甘肃省不同级别医院哮喘患者的控制现状及对疾病认知程度的基线调查. 中国呼吸与危重监护杂志, 2013, 12(5): 446-450.
6. 谢华, 陈萍, 张志远, 等. 施行规范化管理10年单中心住院支气管哮喘患者调查结果分析. 中华结核和呼吸杂志, 2019, 42(3): 179-184.
7. Janson C, Menzies-Gow A, Nan C, et al. SABINA: an overview of short-acting β₂-agonist use in asthma in European countries. Adv Ther, 2020, 37(3): 1124-1135.
8. 周新. 将中国支气管哮喘防治指南推广普及到基层. 中华结核和呼吸杂志, 2018, 41(3): 161-162.
9. 刘春涛. 我国西部地区支气管哮喘防治的瓶颈和对策. 中华结核和呼吸杂志, 2018, 41(3): 2.
10. Shelley M , Croft P, Chapman S, et al. Is the quality of asthma prescribing, as measured by the general practice ratio of corticosteroid to bronchodilator, associated with asthma morbidity? J Clin Epidemiol, 2000, 53(12): 1217-1221.
11. 中华医学会呼吸病学分会哮喘学组. 支气管哮喘防治指南(2020年版). 中华结核和呼吸杂志, 2020, 43(12): 1023-1048.
12. Corrao G, Arfè A, Nicotra F, et al. Persistence with inhaled corticosteroids reduces the risk of exacerbation among adults with asthma: a real-world investigation. Respirology, 2016, 21(6): 1034-1040.
13. Bateman ED , Price DB, Wang HC, et al. Short-acting β₂-agonist prescriptions are associated with poor clinical outcomes of asthma: the multi-country, cross-sectional SABINA III study. Eur Respir J, 2022, 59(5): 2101402.
14. Wang CY, Lai CC, Wang YH, et al. The prevalence and outcome of short-acting β2-agonists overuse in asthma patients in Taiwan. NPJ Prim Care Respir Med, 2021, 31(1): 19.
15. Bloom CI, Saglani S, Feary J, et al. Changing prevalence of current asthma and inhaled corticosteroid treatment in the UK: population-based cohort 2006-2016. Eur Respir J, 2019, 53(4): 1802130.
16. Choi JY, Yoon HK, Lee JH, et al. Nationwide use of inhaled corticosteroids by South Korean asthma patients: an examination of the Health Insurance Review and Service database. J Thorac Dis, 2018, 10(9): 5405-5413.
17. Suruki RY , Daugherty JB , Boudiaf N , et al. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA. BMC Pulm Med, 2017, 17(1): 74.
18. Bleecker ER, Menzies-Gow AN, Price DB, et al. Systematic literature review of systemic corticosteroid use for asthma management. Am J Respir Crit Care Med, 2020, 201(3): 276-293.

Chinese Journal of Respiratory and Critical Care Medicine

A multicenter retrospective longitudinal study of the status of asthma treatment in Chongqing based on medical big data

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