Severe and non-severe asthma in the community: A large electronic database analysis

•Database analysis can identify uncontrolled severe asthmatics needing focused efforts.•Uncontrolled vs. controlled severe-asthmatics were hospitalized 3 times more often.•Severe uncontrolled asthma was associated with cardiopulmonary comorbidities.•25% severe-asthmatics and 1/3 uncontrolled severe-asthmatics visited pulmonologists.•Uncontrolled severe-asthmatics had more GP, pulmonologist, ER, and hospital visits.

BackgroundA large electronic database analysis was conducted in a community of 351,799 people, ages 20-70 years to determine the prevalence and clinical characteristics of severe asthma, according to 2014 international guidelines and healthcare utilization.MethodsSevere asthmatics were grouped into controlled severe-asthma and uncontrolled severe-asthma and additional subgroups of uncontrolled severe asthma on the basis of medications dispensed. Non-asthmatic population at the same ages served as controls.ResultsA total of 19,991 (5.68%) were diagnosed as asthmatic, of which 4.65% had severe asthma. Of these, one-third was uncontrolled severe-asthma. Controlled severe-asthma group was similar to non-severe asthma and non-asthmatics in the rate of emergency room visits (21.5%, 22%, and 20%, respectively) and to all cause hospitalizations (7.4%, 7.4%, and 6.4%, respectively). Uncontrolled severe-asthmatics had significantly more hospitalizations (RR = 2.9) than controlled severe-asthmatics. Only 19.2% of uncontrolled-severe asthmatics had IgE testing and 3.6% were dispensed omalizumab.ConclusionsThe prevalence of severe asthma is slightly less than 5% of all asthmatics. Controlling severe asthma is crucial to reducing healthcare utilization. A simple electronic database analysis, based on dispensed medications, can help healthcare providers identify subgroups of uncontrolled severe asthmatics that require focused efforts.Clinical trial registration: NCT01961258.Ethics Committee approval: 032/2013C.