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Background: There are limited population-based data on the incidence rate (IR) of severe exacerbations (SE) in asthma. Aims: To assess the real world burden of SE and risk of rehospitalisation following an SE using data from 6 European electronic health record databases in the study period 2008-2013. Methods: Patients with asthma, aged ≥5 years and with ≥1 year of follow-up were identified in EHR databases from the Netherlands (IPCI), Italy (HSD and Pedianet), UK (CPRD), Denmark (AUH) and Spain (SIDIAP).Severe asthma was defined as use of high dose ICS + controller therapy for ≥120 days. SE was defined as ED-visit, hospitalization or corticosteroid course for asthma. IRs were calculated for controlled and uncontrolled (≥2 SE in 1 year prior) asthma as the number of SEs divided by the total person-years (PY) during follow-up. Rehospitalisation rates were assessed at 1 month and at 1 year following an asthma-hospitalization. The cumulative incidence (CI) of SE was calculated from the IR. Results: The cohort included 855,806 asthma patients. In severe asthma (n=66,148), the overall IR of SE (per 1000PY) was 46.2 in Pedianet (pediatrics only), 123.4 in HSD, 170.3 in AUH, 172.9 in IPCI, 218.5 in CPRD and 418.0 in SIDIAP. IRs of SE were 4 to 11 fold higher in uncontrolled vs. controlled asthma. Rehospitalization occurred in 7.5-18.4% of patients at 1-month and increased to 34.2-55.3% at 1-year post-hospitalization. Conclusion: In severe asthma patients, the risk of SE is high and up to 18% of patients are rehospitalized during the 1 month post-hospitalization. Prevention of SE, particularly those associated with hospitalization, is important to reduce the burden of asthma. Funding: GSK (PRJ2284).

Background: Patients with severe asthma are at risk of severe exacerbations (SE), which are associated with considerable morbidity and premature death. There is sparse real world evidence on mortality following SE. Aims: To assess the all-cause mortality rate (MR) and MR following SE in patients with asthma and severe asthma using data from six European electronic health record (EHR) databases in the study period 2008-2013. Methods: Patients with asthma, aged ≥5 years and with ≥1 year of follow-up were identified in EHR databases from the Netherlands (IPCI), Italy (HSD and Pedianet), UK (CPRD), Denmark (AUH) and Spain (SIDIAP). Severe asthma was defined as use of high dose ICS + controller therapy for at least 120 days. SE was defined as ED-visit, hospitalization or corticosteroid course for asthma. MR was calculated by dividing the number of deaths by the total person-years (PY). MR following SE was assessed at different time points (7,14,30,90 or 365 days). The cumulative incidence (CI) of mortality was calculated from the IR. Results: The cohort consisted of 855,806 asthma patients. The proportion of severe asthma ranged between 1.7-10.0% (mean age 53.7-62.6 yrs; Pedianet: 9.3 yrs). The all-cause MR in severe asthma ranged between 16.0-33.4/1000PY. MR post-SE in the 1 st week was 26.3-109.5/1000PY (CI0.05-0.21%), and was significantly higher following an ED-visit/hospitalisation alone (57.9-239.4/1000PY; CI0.11-0.46%). Conclusions: MR following an SE is high, especially in the 1 st week following ED- visit/hospitalization. Up to 0.5% of patients died within 7 days of admission. ED visits/hospitalizations should be avoided through improved asthma control. Funding: GSK (PRJ2284).