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Original Article
Exacerbation risk and characterisation of the UK’s asthma population from infants to old age
  1. Chloe I Bloom1,
  2. Francis Nissen2,
  3. Ian J Douglas2,
  4. Liam Smeeth2,
  5. Paul Cullinan1,
  6. Jennifer K Quint1
  1. 1 Department of Respiratory Epidemiology, Occupational Medicine and Public Health, NHLI, Imperial College London, London, UK
  2. 2 Department of Non-communicable Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
  1. Correspondence to Dr Chloe I Bloom, Department of Respiratory Epidemiology, Occupational Medicine and Public Health, NHLI, Imperial College London, London SW7 2AZ, UK; chloe.bloom06{at}


Background Few studies have examined the characteristics of a general asthma population; most have focused on more severe patients or severe exacerbations.

Methods This population-based cohort study, from April 2007 to September 2015, used linked primary and secondary care electronic healthcare records (Clinical Practice Research Datalink, Hospital Episode Statistics). Characteristics of four age cohorts, ‘Under 5s’, ‘5 to 17s’, ‘18 to 54s’, ‘55+’, were described. Exacerbation risk factors, including asthma severity (measured by the British Thoracic Society (BTS) stepwise approach), were assessed using Poisson regression.

Results 424 326 patients with current asthma were eligible (n, median follow-up: ‘Under 5s’=17 320, 1 year; ‘5 to 17s’=82 707, 3.3 years; ‘18 to 54s’=210 724, 4 years; ‘55+’=113 575, 5.1 years). Over 60% of the total study population had mild asthma (BTS steps 1/2). There were differences between the cohort’s characteristics, including by gender, disease severity and exacerbation pattern. The rate of exacerbations was highest in the oldest cohort and lowest in the ‘5 to 17s’ cohort (rate per 10 person-years (95% CI), ‘Under 5s’=4.27 (4.18 to 4.38), ‘5 to 17s’=1.48 (1.47 to 1.50), ‘18 to 54s’=3.22 (3.21 to 3.24), ‘55+’=9.40 (9.37 to 9.42)). In all cohorts, exacerbation rates increased with increasing asthma severity, after adjusting for confounders including gender, socioeconomic status, smoking, body mass index, atopy, rhinitis, gastro-oesophageal reflux, anxiety, depression and COPD.

Conclusion The majority of UK patients with asthma had mild asthma and did not experience an exacerbation during follow-up. Patients aged ≥55 years had the lowest proportion with mild asthma and highest rate of exacerbations; the opposite was found in patients aged between 5 and 18 years.

  • asthma
  • asthma epidemiology
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  • Contributors All authors provided substantial contributions to the work. JKQ and PC devised the study. CIB analysed and interpreted the data and produced draft manuscripts. FN provided data input for the analysis. JKQ, PC, LS, FN and ID commented on analysis and manuscript drafts. All were happy with the final version and approved it for submission for publication.

  • Competing interests None declared.

  • Ethics approval The protocol for this research was approved by the Independent Scientific Advisory Committee (ISAC) for MHRA Database Research (protocol 16_067); the approved protocol was made available during peer review. Generic ethical approval for observational research using the CPRD with approval from ISAC has been granted by a Health Research Authority Research Ethics Committee (East Midlands–Derby, REC reference number 05/MRE04/87).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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