Purpose: Patients with asthma in Singapore often have complex patient journeys, with diagnosis and management across various primary and speciality care settings. Real-world population health data is needed to identify care gaps and inform policies.
Patients and methods: This retrospective, longitudinal cohort study assessed real-world data from adults (aged ≥18 years) with asthma in the SingHealth Chronic Obstructive Pulmonary Disease and Asthma Data Mart, an integrated database of electronic medical records of patients who attended primary and/or speciality care clinics in the SingHealth Regional Health System 01/01/2015-12/31/2020. Patients were indexed by first asthma diagnosis and categorized into cohorts of index year. Patient characteristics, asthma management and outcomes were described during baseline (1-year pre-index) and follow-up periods (1-year post-index).
Results: Overall, 21,215 patients were included across 4 cohorts: 2016, N=12,947; 2017, N=3419; 2018, N=2816; 2019, N=2033. Most common baseline asthma medication changed from inhaled corticosteroids (ICS) alone in the 2016 cohort (32.8% [n=4252]) to ICS/long-acting β2-agonist in the 2019 cohort (33.3% [n=677]). Asthma symptom control (mean [SD] Asthma Control Test scores) improved from 2016 to 2019 during baseline (18.38 [4.93] vs 19.87 [4.56]; p<0.001) and follow-up (18.34 [4.23] vs 21.07 [3.51]; p<0.001). Mean (standard deviation [SD]) number of exacerbations per patient during follow-up decreased from 2016 to 2019 (1.91 [3.11] vs 0.89 [2.07]; p<0.001). Mean (SD) number of emergency department visits per patient during follow-up decreased from 0.21 (0.75) in 2016 to 0.17-0.18 (0.60-0.65; p<0.001) between 2017 and 2019.
Conclusion: Health status at first asthma diagnosis improved for each succeeding cohort from 2016 to 2019, along with improvements in patient management and outcomes. This reflects greater awareness of the condition and improved use of medication and referrals in recent years, suggesting policy changes and their implementation, including promotion of disease awareness and adoption of guideline recommendations, may improve asthma outcomes in Singapore.
Keywords: Singapore; asthma; asthma control; exacerbations; health outcomes; real world.
In Singapore, up to 4 in 100 people are living with asthma. People with asthma can experience frequent symptoms and attacks that affect day-to-day activities, create emotional stress and reduce quality of life. Asthma has a financial impact on patients and the economy, as it can lead to missed work and reduced productivity. In Singapore, managing asthma can be complex, with patients often seeing both primary care physicians and specialists from diagnosis to treatment. This study assessed trends in the care that patients with asthma in Singapore received and their outcomes over a 4-year period. Patients’ medical records from primary and specialist care were collected for 1 year before and after their asthma diagnosis to determine whether treatment changed over time, whether symptoms improved and whether use of healthcare services changed. Between 2016 and 2019, patients with asthma had fewer, less severe asthma attacks, and fewer emergency department visits over time. The treatment types also changed; in 2019 versus 2016, more patients received combination inhalers of corticosteroids with a long-acting beta 2 (β2) agonist, or other add-on treatments, which improve patients’ asthma, including symptoms. This indicates that there was an increasing trend for physicians following new guidelines for recommended asthma care and these changes in practice ensured combination inhalers were made available to patients by the government, leading to improvement in asthma outcomes. This study shows that asthma management in Singapore improved over the 4-year period, potentially through healthcare professionals taking on board improved treatment guideline recommendations and policy changes.
© 2024 Koh et al.