Aim: Improved understanding of patient characteristics associated with exacerbations (EXBs) may provide opportunity to minimize future risk. We assessed whether database asthma control can predict future EXBs. Methods: Used a research database to select clinical records of patients aged 18–60yrs with an asthma diagnosis, continuous records over 1 baseline & 1 outcome yr and no other chronic respiratory disease or maintenance oral steroids. Two baseline control measures were evaluated: risk domain asthma control (RDAC) & overall control (OAC). RDAC was absence of: exacerbations, unplanned asthma-related out patient appointments, and antibiotics with evidence of respiratory review (ABX). OAC was: RDAC+average salbutamol ≤200µg/day. RDAC/OAC components predictive of outcome EXBs in univariable models were entered into a multivariable model and stepwise reduced. EXBs were: oral steroid courses with evidence of respiratory review (OS), asthma-related hospital admission or emergency room [ER] attendance. Results: Of 1558 patients (60% female), 73% and 42% satisfied criteria for RDAC and OAC control, respectively, at baseline. Baseline Predictors of EXB risk Rate Ratio(95%CI) p-value Univariable analysis RDAC (uncontrolled)∗ 2.78(2.04–3.70) <0.001 OAC (uncontrolled)∗ 1.69(1.23–2.33) <0.001 OS 0 1.00 1 2.33(1.58–3.42) <0.001 ≤2 2.53(1.54–4.17) ER attendance 0 1.00 1 1.58(1.06–2.34) <0.001 ≤2 2.43(1.59–3.71) ER attendance 0 1.00 0.037 ≤1 2.21(1.05–4.66) ∗Controlled RR=1.00 Conclusions: Classification as RDAC or OAC at baseline predicted lower EXB rates in the following year. OS, ABX and asthma-related ER attendance independently predicted increased EXB risk regardless of “current control” as indicated by salbutamol use.
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