BACKGROUND: Exacerbation frequency strongly influences treatment choices in patients with severe asthma. RESEARCH QUESTION: What is the extent of the variability of exacerbations rate across countries and its implications in disease management? STUDY DESIGN AND METHODS: We retrieved data from the International Severe Asthma Registry, an international observational cohort of patients with a clinical diagnosis of severe asthma. We identified patients ≥ 18 years of age who did not initiate any biologics prior to baseline visit. A severe exacerbation was defined as the use of oral corticosteroids for ≥ 3 days or asthma-related hospitalization/ED visit. A series of negative binomial models were applied to estimate country-specific severe exacerbation rates during 365 days of follow-up, starting from a naïve model with country as the only variable to an adjusted model with country as a random-effect term and patient and disease characteristics as independent variables. RESULTS: The final sample included 7,510 patients from 17 countries (56% from the United States), contributing to 1,939 severe exacerbations (0.27/person-year). There was large between-country variation in observed severe exacerbation rate (minimum, 0.04 [Argentina]; maximum, 0.88 [Saudi Arabia]; interquartile range, 0.13-0.54), which remained substantial after adjusting for patient characteristics and sampling variability (interquartile range, 0.16-0.39). INTERPRETATION: Individuals with similar patient characteristics but coming from different jurisdictions have varied severe exacerbation risks, even after controlling for patient and disease characteristics. This suggests unknown patient factors or system-level variations at play. Disease management guidelines should recognize such between-country variability. Risk prediction models that are calibrated for each jurisdiction will be needed to optimize treatment strategies.
BACKGROUND: Information about the clinical and epidemiological characteristics of atopic dermatitis (AD) is essential to generate knowledge of the disease and its socioeconomic impact. OBJECTIVE: To describe the clinical characteristics of the patients of an atopic dermatitis clinic. METHODS: An observational, retrospective, and cross-sectional study. Demographic data, severity of the AD (according to the Eczema Area Severity Index), clinical phenotype, total serum IgE, the presence of allergic and non-allergic comorbidities, as well as of anxiety and depression, were recorded by means of targeted questionnaire and Hamilton Scale. Descriptive and inferential statistics were obtained, considering a statistical significance associated with a value of p <0.05. RESULTS: 187 patients were included; the median age was 12 years with a range of 1-87 years. Differences were found regarding sex and severity (p < 0.05). Mild forms of AD were presented in 57.8% of the patients, moderate forms in 20.9%, and severe forms in 21.4%. The severity was associated with allergic comorbidities such as asthma (p = 0.001) and allergic conjunctivitis (p <0.001). Severe AD was associated with a state of anxiety and depression (p <0.05), as well as with ocular affectation (p<0.001). CONCLUSION: The pediatric population is the most affected by AD; however, in the adult population, the severe form associated with allergic comorbidities is observed.
Antecedentes: Los datos sobre características clínicas y epidemiológicas de la dermatitis atópica son fundamentales para generar conocimiento sobre la enfermedad y su impacto socioeconómico. Objetivo: Describir las características clínicas de los pacientes de una clínica de dermatitis atópica. Métodos: Estudio observacional, retrospectivo y transversal. Se registraron datos demográficos, gravedad de la dermatitis atópica (según el Eczema Area Severity Index), fenotipo clínico, IgE sérica total, presencia de comorbilidades alérgicas y no alérgicas, así como de ansiedad y depresión mediante interrogatorio dirigido y escala de Hamilton. Se realizó estadística descriptiva e inferencial, considerando una significación estadística con p < 0.05. Resultados: Se incluyeron 187 pacientes, la edad tuvo una mediana de 12 años, con un rango de uno a 87 años. Se encontraron diferencias respecto al sexo y gravedad (p < 0.05). La dermatitis atópica leve se presentó en 57.8 %, la moderada en 20.9 % y la grave en 21.4 %. La gravedad estuvo asociada a comorbilidades alérgicas como asma (p = 0.001) y conjuntivitis alérgica (p < 0.001). La dermatitis atópica grave se asoció a ansiedad y depresión (p < 0.05), así como afectación ocular (p < 0.001). Conclusión: Lo población pediátrica es la más afectada por dermatitis atópica, pero en los adultos se observa la forma grave asociada a comorbilidades alérgicas.
Conjunctivitis, Allergic , Dermatitis, Atopic , Eczema , Adolescent , Adult , Aged , Aged, 80 and over , Child , Child, Preschool , Cross-Sectional Studies , Dermatitis, Atopic/epidemiology , Humans , Infant , Middle Aged , Retrospective Studies , Severity of Illness Index , Young Adult
