Asthma is common chest condition that can cause shortness of breath and wheeze. Long-term asthma care is provided by GPs and Practice Nurses and includes reviews of symptoms and medication. Some peoples asthma improves and resolves over time. There is no guidance on whether these people need on-going reviews and therefore they are mostly not routinely followed up by their General Practice unless they present with a problem. We do not know if these people remain at greater risk of asthma recurrence or respiratory infection. In the proposed study, we aim to determine the risk of asthma and respiratory infection-related hospitalisation and death in people with resolved asthma, compared to people with active asthma and people who have never had asthma. This will help us to understand whether people with resolved asthma remain at risk of adverse events and plan and deliver better care to try and prevent these adverse events from occurring.
Asthma is the most common respiratory condition in the UK. Long-term asthma management is part of the Quality and Outcomes Framework and GPs receive financial incentives to meet certain asthma quality performance indicators. Some patients asthma may improve and resolve over time, leading to a recorded diagnosis of resolved asthma which exempts them from asthma quality performance indicators and means they may no longer be routinely followed-up or reviewed in primary care. The Quality and Outcomes Framework suggests documenting resolved asthma in a patients medical record if they have not needed to use any asthma medications for >12 months. Current clinical guidelines offer no advice on long-term care or follow-up of patients with resolved asthma. We hypothesise that these patients remain at greater risk of asthma and respiratory infection-related hospitalisation than population-based controls with no history of asthma. To test this hypothesis, we will do a cohort study, matching patients with resolved asthma to non-asthmatic controls on age, gender, and practice, and estimating incidence rate ratios (IRRs) for asthma and respiratory infection-related hospitalisation and deaths using Poisson regression models adjusted for measured confounders. We will also compare the incidence of these outcomes between patients with resolved asthma and active ongoing asthma. In addition, we will do descriptive analyses focussed on the prevalence and clinical management of resolved asthma in UK primary care. These analyses will help us to understand how best to organise and deliver long-term care to this group of patients.
1. Prevalence of resolved asthma
2. Sociodemographic and clinical variables associated with a record of resolved asthma
3. Asthma-related hospital admissions [ICD-10 codes J45] and length of stay
4. Respiratory infection-related hospital admissions [ICD-10 codes J00-J06 (acute upper respiratory tract infections), J09-J18 (influenza and pneumonia), and J20-J22 (acute lower respiratory tract infections).
5. Asthma or respiratory infection-related death.
Harry Ahmed - Chief Investigator - Cardiff University
Harry Ahmed - Corresponding Applicant - Cardiff University
Bethan Cumins - Collaborator - Cardiff University
Hywel M. Jones - Collaborator - Cardiff University
Rebecca Cannings-John - Collaborator - Cardiff University
HES Admitted Patient Care;ONS Death Registration Data;Patient Level Index of Multiple Deprivation