Hospital admission rates for patients with chronic obstructive pulmonary disease (COPD) and asthma increased by 59.1% in England and Wales between 1999 and 2020, a 21-year follow-up study reported.
COPD accompanied by acute lower respiratory infection accounted for 38.7% of hospital admissions, and more than half of admitted patients were female.
“Hospital admissions due to chronic obstructive pulmonary disease and asthma, as well as medication prescriptions, increased dramatically among all age groups,” the researchers wrote, also noting “hospitalization rates were higher for women.”
The findings were reported in “Trends in hospital admissions and prescribing due to chronic obstructive pulmonary disease and asthma in England and Wales between 1999 and 2020: an ecological study.” The study was published in the journal BMC Pulmonary Medicine.
Hospital admission rates jump in England and Wales over 21 years
COPD and asthma are the most frequent chronic respiratory diseases worldwide. In 2019, COPD was estimated to affect 391.9 million people ages 30-79 worldwide, while asthma was estimated to affect around 262 million, according to the researchers.
In the U.K. — which is comprised of England, Scotland, Wales, and Northern Ireland — estimates indicate that COPD affects more than 3 million people. According to the British Lung Foundation, asthma affects about 8 million people, corresponding to more than 12% of the U.K. population.
In the past two decades, the rate of hospitalizations for chronic lower respiratory diseases, including asthma and COPD, has increased by 55.1% in England and Wales. Annual costs for healthcare and due to mortality have been projected to increase, by 2030, to £2.32 billion ($2.8 billion) in England alone.
Now, a team led by researchers in Saudi Arabia and Jordan assessed the trends in hospitalization admissions and medication prescriptions associated with COPD and asthma in England and Wales.
To that end, they analyzed data collected between April 1999 and April 2020 from the Hospital Episode Statistics (HES) database in England and the Patient Episode Database for Wales (PEDW).
The analysis revealed the total annual rate for COPD and asthma hospital admissions significantly increased, by 59.1%, over that 21-year span. Specifically, the rate jumped from 403.77 per 100,000 people in 1999 to 642.42 per 100,000 people in 2020.
Hospital admissions due to chronic obstructive pulmonary disease and asthma, as well as medication prescriptions, increased dramatically among all age groups.
The most frequent cause for hospitalization was COPD accompanied by acute lower respiratory infection (38.7 %), asthma (30 %), and COPD with acute exacerbation, or symptom worsening (25.5 %).
During the period of the analysis, the rate of hospital admissions due to acute lower respiratory infection in COPD patients increased 1.99 times.
Overall, the admission rates related to COPD increased by 65.5 %, while the rate of in-patient hospital stays associated with asthma increased 46.1%.
Patients ages 75 and older accounted for 34.7% of the total COPD and asthma-related hospital admissions, followed by those ages 60-74, who accounted for 33%. Those younger than age 15 accounted for the lowest proportion of hospital admissions (8.8%).
Hospitalization rates for COPD and asthma among patients ages 75 and older increased by 53.8% — from a mean of 1,681.08 per 100,000 people in 1999 to 2,586.24 per 100,000 people in 2020.
A total of 3,264,503 hospitalizations were of female patients, representing 53.8% of total admissions related to COPD and asthma.
The hospital admission rate for females with COPD and asthma increased by 87.2% — from 389.14 per 100,000 people in 1999 to 728.40 per 100,000 people in 2020. This increase in hospital admission rates was lower for male patients (32.3%).
COPD-related admissions were directly associated with age, with higher rates seen among older patients (ages 75 and older). Asthma-related hospitalizations were more common for patients younger than age 15, followed by those ages 75 and older.
The total number of medication prescriptions for COPD and asthma dispensed annually in England and Wales increased by 42.2% — from 42,062,859 in 2004 to 59,819,658 in 2020.
Bronchodilators — medications that help relax and open the airways to make breathing easier — were the most commonly prescribed medicines (59.1%), followed by corticosteroids (37.3%).
Prescriptions for corticosteroids increased by 40.3% and those of bronchodilators by 12.1%. Moreover, in the past 16 years, a 3.20 times increase in the number of prescriptions was observed for specific medications, including phosphodiesterase 4 (PDE4) inhibitors. PDE4 is involved in muscle contraction and airway inflammation, and inhibitors of its activity are sometimes used to treat COPD.
“Our study showed that the admission rates of COPD and asthma in England and Wales increased by an average of 3.9% each year,” the researchers wrote.
“Further observational and epidemiological research is required to identify the factors contributing to increased hospitalization rates,” the they concluded.