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Carlos A Camargo - One of the best experts on this subject based on the ideXlab platform.
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association of obstructive sleep apnea with all cause readmissions after hospitalization for Asthma Exacerbation in adults aged 18 54 years a population based study 2010 2013
Journal of Asthma, 2020Co-Authors: Atsushi Hirayama, Carlos A Camargo, Tadahiro Goto, Mohammad Kamal Faridi, Kohei HasegawaAbstract:Objective: To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for Asthma Exacerbation.Methods: We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18-54 years) hospitalized for Asthma Exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for Asthma Exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission.Results: Among 65,731 patients hospitalized for Asthma Exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54-1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases-Asthma (IRR 1.21; 95%CI 1.15-1.27), COPD (IRR 2.03; 95%CI 1.88-2.19), respiratory failure (IRR 3.04; 95%CI 2.76-3.34), pneumonia (IRR 1.67; 95%CI 1.49-1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36-4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50-1.62). These associations remained significant after adjustment for confounders.Conclusions: The observed association of OSA with a higher risk of readmissions after hospitalization for Asthma Exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and Asthma management.
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risk of acute myocardial infarction and ischemic stroke in patients with Asthma Exacerbation a population based self controlled case series study
The Journal of Allergy and Clinical Immunology: In Practice, 2020Co-Authors: Yoshihiko Raita, Carlos A Camargo, Mohammad Kamal Faridi, David F M Brown, Yuichi J Shimada, Kohei HasegawaAbstract:Background Patients with Asthma have a high incidence of acute myocardial infarction and ischemic stroke. Objective To investigate the acute effect of Asthma Exacerbation on these cardiovascular events. Methods Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with Asthma Exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after Asthma Exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods). Results We identified 4607 adults hospitalized for Asthma Exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P Conclusions In this population-based study of adults with Asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after Asthma Exacerbation.
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association between obesity and acute severity among patients hospitalized for Asthma Exacerbation
The Journal of Allergy and Clinical Immunology: In Practice, 2018Co-Authors: Sarah Kyuragi Luthe, Carlos A Camargo, Atsushi Hirayama, Tadahiro Goto, Mohammad Kamal Faridi, Kohei HasegawaAbstract:Background Although studies have demonstrated relations between obesity and incident Asthma, little is known about the association of obesity with acute severity in adults hospitalized for Asthma Exacerbation. Objectives To investigate the association of obesity with acute severity of Asthma Exacerbation. Methods This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for Asthma Exacerbation. The outcome measures were markers of acute severity—use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals. Results Among the 72,086 patients hospitalized for Asthma Exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P Conclusions In this population-based study of adults hospitalized for Asthma Exacerbation, obesity was associated with higher acute severity.
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smoking status and smoking cessation intervention among u s adults hospitalized for Asthma Exacerbation
Allergy and Asthma Proceedings, 2016Co-Authors: Jane C Bittner, Kohei Hasegawa, Beatrice D Probst, Neekofi Mouldmillman, Robert Silverman, Carlos A CamargoAbstract:BACKGROUND In a previous multicenter study during 1999-2000, we found a high prevalence of smoking among patients hospitalized for Asthma Exacerbations (35%) and suboptimal smoking cessation efforts. There have been no recent multicenter efforts to examine the smoking status and implementation of smoking cessation efforts among patients hospitalized for Asthma Exacerbation. OBJECTIVE To investigate the prevalence of cigarette smoking and the proportion and characteristics of patients who received an inpatient smoking cessation intervention. METHODS We conducted a secondary analysis of a 25-center observational study, which included 597 U.S. adults hospitalized for Asthma Exacerbation during 2012-2013. RESULTS Among the analytic cohort, 215 (36%) were current smokers. In the multivariable model, compared with patients with private health insurance, those with public health insurance (odds ratio [OR] 1.71 [95% confidence interval {CI}, 1.06-2.77]) or no health insurance (OR 1.75 [95% CI, 1.02-2.99]) were more likely to be current smokers. By contrast, patients with a previous evaluation by an Asthma specialist in the past 12 months (OR 0.49 [95% CI, 0.28-0.86]) and use of inhaled corticosteroids (OR 0.63 [95% CI, 0.43-0.93]) were less likely to be current smokers. Among current smokers, only 55% received smoking cessation interventions during their hospitalization. In the multivariable model, current smokers who had public health insurance (OR 0.25 [95% CI, 0.07-0.82]) or no health insurance (OR 0.26 [95% CI, 0.07-0.94]) were less likely to receive inpatient smoking cessation interventions compared with those with private health insurance. CONCLUSION Our findings showed a persistently high prevalence of smokers among U.S. patients hospitalized for Asthma Exacerbations and an underutilized opportunity to provide this at-risk population with smoking cessation interventions.
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age related differences in the rate timing and diagnosis of 30 day readmissions in hospitalized adults with Asthma Exacerbation
Chest, 2016Co-Authors: Kohei Hasegawa, Yusuke Tsugawa, Yuichi J Shimada, Koichiro Gibo, Carlos A CamargoAbstract:Background Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after Asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. Objectives To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with Asthma and to determine age-related differences. Methods Retrospective cohort study of adults hospitalized for Asthma Exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. Results Of 301,164 Asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P P P Conclusions After Asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.
Kohei Hasegawa - One of the best experts on this subject based on the ideXlab platform.
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association of obstructive sleep apnea with all cause readmissions after hospitalization for Asthma Exacerbation in adults aged 18 54 years a population based study 2010 2013
Journal of Asthma, 2020Co-Authors: Atsushi Hirayama, Carlos A Camargo, Tadahiro Goto, Mohammad Kamal Faridi, Kohei HasegawaAbstract:Objective: To investigate associations between obstructive sleep apnea (OSA) and readmission risk after hospitalization for Asthma Exacerbation.Methods: We conducted a retrospective, population-based cohort study using State Inpatient Databases from seven U.S. states (Arkansas, California, Florida, Iowa, Nebraska, New York, and Utah) from 2010 to 2013. We identified all adults (aged 18-54 years) hospitalized for Asthma Exacerbation. The outcome measure was all-cause readmissions within one year after hospitalization for Asthma Exacerbation. To determine associations between OSA and readmission risk, we constructed negative binomial regression models estimating the incidence rate ratio (IRR) for readmissions and Cox proportional hazards models estimating hazard rate (HR) for the time-to-first readmission.Results: Among 65,731 patients hospitalized for Asthma Exacerbation, 6,549 (10.0%) had OSA. Overall, OSA was associated with significantly higher incident rate of all cause readmission (1.36 vs. 0.85 readmissions per person-year; unadjusted IRR 1.60; 95%CI 1.54-1.66). Additionally, OSA was associated with higher incident rates of readmissions for five major diseases-Asthma (IRR 1.21; 95%CI 1.15-1.27), COPD (IRR 2.03; 95%CI 1.88-2.19), respiratory failure (IRR 3.04; 95%CI 2.76-3.34), pneumonia (IRR 1.67; 95%CI 1.49-1.88), and congestive heart failure (IRR 3.78; 95%CI 3.36-4.24), compared to non-OSA. The Cox model demonstrated that patients with OSA had significantly higher rates for all-cause readmission compared to those without OSA (HR 1.56; 95% CI 1.50-1.62). These associations remained significant after adjustment for confounders.Conclusions: The observed association of OSA with a higher risk of readmissions after hospitalization for Asthma Exacerbation underscores the importance of identifying coexistent OSA in this population and optimizing both OSA and Asthma management.
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risk of acute myocardial infarction and ischemic stroke in patients with Asthma Exacerbation a population based self controlled case series study
The Journal of Allergy and Clinical Immunology: In Practice, 2020Co-Authors: Yoshihiko Raita, Carlos A Camargo, Mohammad Kamal Faridi, David F M Brown, Yuichi J Shimada, Kohei HasegawaAbstract:Background Patients with Asthma have a high incidence of acute myocardial infarction and ischemic stroke. Objective To investigate the acute effect of Asthma Exacerbation on these cardiovascular events. Methods Using population-based inpatient data of 3 geographically diverse US states (Florida, Nebraska, and New York) during the period 2011 to 2014, we conducted a self-controlled case series study of adults (aged ≥40 years) hospitalized with Asthma Exacerbation. The primary outcome was a composite of acute myocardial infarction and ischemic stroke. We used conditional Poisson regression to compare each patient's incidence rate of the outcome during 3 sequential risk periods (1-7, 8-14, and 15-28 days after Asthma Exacerbation) with that of the reference period (ie, summed period before and after the 3 risk periods). Results We identified 4607 adults hospitalized for Asthma Exacerbation who had a first episode of acute myocardial infarction or ischemic stroke. During the reference period, the incidence rate of acute myocardial infarction or ischemic stroke was 25.0/100 person-years. Compared with the reference period, the incidence rate significantly increased during the first risk period (129.1/100 person-years), with a corresponding adjusted incidence rate ratio of 5.04 (95% CI, 4.29-5.88; P Conclusions In this population-based study of adults with Asthma, the risk of acute myocardial infarction and ischemic stroke increased significantly after Asthma Exacerbation.
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association between obesity and acute severity among patients hospitalized for Asthma Exacerbation
The Journal of Allergy and Clinical Immunology: In Practice, 2018Co-Authors: Sarah Kyuragi Luthe, Carlos A Camargo, Atsushi Hirayama, Tadahiro Goto, Mohammad Kamal Faridi, Kohei HasegawaAbstract:Background Although studies have demonstrated relations between obesity and incident Asthma, little is known about the association of obesity with acute severity in adults hospitalized for Asthma Exacerbation. Objectives To investigate the association of obesity with acute severity of Asthma Exacerbation. Methods This is a retrospective cohort study using population-based data of 8 geographically diverse US states from 2010 through 2013. We included adults (age 18-54 years) hospitalized for Asthma Exacerbation. The outcome measures were markers of acute severity—use of mechanical ventilation (defined by noninvasive positive pressure ventilation and/or invasive mechanical ventilation) and hospital length of stay. To determine the association of obesity with each outcome, we fit multivariable models adjusting for patient-level confounders (eg, age, sex, race/ethnicity, primary insurance, quartiles for household income, residential status, and comorbidities) and potential patient clustering within hospitals. Results Among the 72,086 patients hospitalized for Asthma Exacerbation, 24% were obese. Obesity was associated with a significantly higher risk of any mechanical ventilation use (8.3% vs 5.0%; adjusted odds ratio [OR], 1.77; 95% CI, 1.63-1.92; P Conclusions In this population-based study of adults hospitalized for Asthma Exacerbation, obesity was associated with higher acute severity.
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smoking status and smoking cessation intervention among u s adults hospitalized for Asthma Exacerbation
Allergy and Asthma Proceedings, 2016Co-Authors: Jane C Bittner, Kohei Hasegawa, Beatrice D Probst, Neekofi Mouldmillman, Robert Silverman, Carlos A CamargoAbstract:BACKGROUND In a previous multicenter study during 1999-2000, we found a high prevalence of smoking among patients hospitalized for Asthma Exacerbations (35%) and suboptimal smoking cessation efforts. There have been no recent multicenter efforts to examine the smoking status and implementation of smoking cessation efforts among patients hospitalized for Asthma Exacerbation. OBJECTIVE To investigate the prevalence of cigarette smoking and the proportion and characteristics of patients who received an inpatient smoking cessation intervention. METHODS We conducted a secondary analysis of a 25-center observational study, which included 597 U.S. adults hospitalized for Asthma Exacerbation during 2012-2013. RESULTS Among the analytic cohort, 215 (36%) were current smokers. In the multivariable model, compared with patients with private health insurance, those with public health insurance (odds ratio [OR] 1.71 [95% confidence interval {CI}, 1.06-2.77]) or no health insurance (OR 1.75 [95% CI, 1.02-2.99]) were more likely to be current smokers. By contrast, patients with a previous evaluation by an Asthma specialist in the past 12 months (OR 0.49 [95% CI, 0.28-0.86]) and use of inhaled corticosteroids (OR 0.63 [95% CI, 0.43-0.93]) were less likely to be current smokers. Among current smokers, only 55% received smoking cessation interventions during their hospitalization. In the multivariable model, current smokers who had public health insurance (OR 0.25 [95% CI, 0.07-0.82]) or no health insurance (OR 0.26 [95% CI, 0.07-0.94]) were less likely to receive inpatient smoking cessation interventions compared with those with private health insurance. CONCLUSION Our findings showed a persistently high prevalence of smokers among U.S. patients hospitalized for Asthma Exacerbations and an underutilized opportunity to provide this at-risk population with smoking cessation interventions.
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age related differences in the rate timing and diagnosis of 30 day readmissions in hospitalized adults with Asthma Exacerbation
Chest, 2016Co-Authors: Kohei Hasegawa, Yusuke Tsugawa, Yuichi J Shimada, Koichiro Gibo, Carlos A CamargoAbstract:Background Reducing hospital readmissions has attracted attention from many stakeholders. However, the characteristics of 30-day readmissions after Asthma-related hospital admissions in adults are not known. It is also unclear whether older adults are at higher risk of 30-day readmission. Objectives To investigate the rate, timing, and principal diagnosis of 30-day readmissions in adults with Asthma and to determine age-related differences. Methods Retrospective cohort study of adults hospitalized for Asthma Exacerbation using the population-based inpatient samples of three states (California, Florida, and Nebraska) from 2005 through 2011. Patients were categorized into three age groups: younger (18-39 years), middle aged (40-64 years), and older (≥ 65 years) adults. Outcomes were 30-day all-cause readmission rate, timing, and principal diagnosis of readmission. Results Of 301,164 Asthma-related admissions at risk for 30-day readmission, readmission rate was 14.5%. Compared with younger adults, older adults had significantly higher readmission rates (10.1% vs 16.5%; OR, 2.15 [95% CI, 2.07-2.23]; P P P Conclusions After Asthma-related admission, 14.5% of patients had 30-day readmission with wide range of principal diagnoses. Compared with younger adults, older adults had higher 30-day readmission rates and proportions of nonrespiratory diagnoses.
Alexandre Demoule - One of the best experts on this subject based on the ideXlab platform.
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Management of severe Asthma Exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies
Annals of Intensive Care, 2019Co-Authors: Philippe Le Conte, Nicolas Terzi, Guillaume Mortamet, Fekri Abroug, Guillaume Carteaux, Céline Charasse, Anthony Chauvin, Xavier Combes, Stephane Dauger, Alexandre DemouleAbstract:The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe Asthma Exacerbation (SAE) in adult and pediatric patients.
Philippe Le Conte - One of the best experts on this subject based on the ideXlab platform.
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Management of severe Asthma Exacerbation: guidelines from the Société Française de Médecine d’Urgence, the Société de Réanimation de Langue Française and the French Group for Pediatric Intensive Care and Emergencies
Annals of Intensive Care, 2019Co-Authors: Philippe Le Conte, Nicolas Terzi, Guillaume Mortamet, Fekri Abroug, Guillaume Carteaux, Céline Charasse, Anthony Chauvin, Xavier Combes, Stephane Dauger, Alexandre DemouleAbstract:The French Emergency Medicine Society, the French Intensive Care Society and the Pediatric Intensive Care and Emergency Medicine French-Speaking Group edited guidelines on severe Asthma Exacerbation (SAE) in adult and pediatric patients.
Matthew A Rank - One of the best experts on this subject based on the ideXlab platform.
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the risk of Asthma Exacerbation after reducing inhaled corticosteroids a systematic review and meta analysis of randomized controlled trials
Allergy, 2014Co-Authors: John B Hagan, Shefali Samant, Gerald W Volcheck, Patricia J Erwin, Christina R Hagan, Matthew A RankAbstract:Background Asthma guidelines suggest reducing controller medications when Asthma is stable. Methods The purpose of the study is to estimate the risk of Asthma Exacerbation in stable Asthmatics who reduce inhaled corticosteroids (ICS) compared to those who maintain a stable ICS dose. We identified articles from a systematic review of English and non-English articles using MEDLINE, EMBASE, Web of Science, and CENTRAL (inception to May 25, 2013). We included randomized controlled trials (RCTs) with a stable Asthma run-in period of 4 weeks or more, an intervention to reduce ICS, and a follow-up period of at least 3 months. Results The search strategy identified 2253 potential articles, of which 206 were reviewed at the full-text level and 6 met criteria for inclusion. The relative risk of an Asthma Exacerbation in individuals who reduced ICS compared to those who maintained the same ICS dose was 1.25 (95% CI 0.96, 1.62; P = 0.10; I2 = 0%) in studies with a mean follow-up of 22 weeks. Individuals who reduced ICS had a decreased% predicted FEV1 of 0.87% (95% CI −1.58%,3.33%; P = 0.49, I2 = 58%) and a decreased mean morning peak expiratory flow of 9.57 l/min (95% CI 1.25, 17.90; P = 0.02; I2 = 74%) compared to those individuals who maintained a stable ICS dose. Conclusions Asthma Exacerbations were statistically no more likely among individuals who reduced ICS compared to those who maintained their ICS dose, supporting current guidelines which recommend decreasing ICS by 50% after a period of Asthma stability.
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the risk of Asthma Exacerbation after stopping low dose inhaled corticosteroids a systematic review and meta analysis of randomized controlled trials
The Journal of Allergy and Clinical Immunology, 2013Co-Authors: Matthew A Rank, John B Hagan, Miguel A Park, Jenna C Podjasek, Shefali Samant, Gerald W Volcheck, Patricia J Erwin, Colin P WestAbstract:Background Current Asthma guidelines suggest that patients and their providers consider decreasing or stopping controller medications when Asthma is stable. Objective We sought to estimate the risk of Asthma Exacerbation in patients who stop low-dose inhaled corticosteroids (ICSs) compared with those who continue ICSs in randomized controlled trials. Methods We identified relevant trials from a systematic review of English-language and non–English-language articles using MEDLINE, EMBASE, and CENTRAL (inception to January 21, 2012). Articles were screened at the abstract and full-text level by 2 independent reviewers. We included randomized controlled trials with a stable Asthma run-in period of 4 weeks or more, an intervention to stop or continue ICSs, and a follow-up period of at least 3 months. We pooled results using a random-effects meta-analysis. Results The search strategy identified 1798 potential articles, of which 172 were reviewed at the full-text level and 7 met the criteria for inclusion. The relative risk for an Asthma Exacerbation in patients who stopped ICSs compared with those who continued use was 2.35 (95% CI, 1.88-2.92; P 2 = 0%), as determined by using data pooled from trials with a mean follow-up of 27 weeks. The pooled absolute risk difference for an Asthma Exacerbation was 0.23 (95% CI, 0.16-0.30; P 2 = 44%). Patients who discontinued ICSs also had a decreased FEV 1 of 130 mL (95% CI, 40-210 mL; P = .003; I 2 = 53%), a decreased mean morning peak expiratory flow of 18 L/min (95% CI, 6-29 L/min; P = .004; I 2 = 82%), and an increased mean standardized Asthma symptom score of 0.43 SDs (95% CI, 0.28-0.58 SDs; P 2 = 0%). Conclusion Patients with well-controlled Asthma who stop regular use of low-dose ICSs have an increased risk of an Asthma Exacerbation compared with those who continue ICSs.
