{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,4]],"date-time":"2026-03-04T12:13:08Z","timestamp":1772626388134,"version":"3.50.1"},"reference-count":47,"publisher":"BMJ","issue":"3","funder":[{"DOI":"10.13039\/501100003710","name":"Korea Health Industry Development Institute","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100003710","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2018,1,31]]},"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>Asthma exacerbation, associated with many risks factors, can reflect management failure. However, little is known about how risk factors are associated with exacerbation, according to asthma severity. We aimed to investigate differences in risk factors in patients with different asthma severity and evaluate whether risk factors differed between frequent exacerbators and patients with single exacerbation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Nationwide population-based observational study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Korean National Sample Cohort database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>We included 22\u2009130 adults with asthma diagnoses more than twice (ICD-10 (International Classification of Diseases, Tenth revision) codes J45 and J46) and one prescription for asthma medication from 2010 to 2011.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Outcome measures<\/jats:title>\n                    <jats:p>Asthma exacerbation was defined as having a corticosteroid (CS) burst characterised by a prescription of high-dose oral CS for \u22653 days or one systemic CS injection, hospitalisation or emergency department visit.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Among severities, history of CS bursts was significantly associated with exacerbation. In mild and moderate asthma, exacerbation was significantly associated with age \u226545 years, being female, gastro-oesophageal reflux disease and chronic rhinitis. High medication possession ratio (MPR\u226550%), compared with low MPR (&lt;20%) showed adjusted ORs of 0.828 (95% CI 0.707 to 0.971) and 0.362 (0.185 to 0.708) in moderate and severe asthma, respectively. In severe asthma, compared with mild asthma, only allergic rhinitis and history of hospitalisation were strongly associated with exacerbation. When comparing frequent exacerbators to patients with single exacerbation, age \u226545 years, atopic dermatitis, anxiety and history of CS burst were significant risk factors in mild and moderate asthma, whereas no risk factors were significant in severe asthma.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Different associations between risk factors and asthma exacerbations based on asthma severity suggest that patients with mild asthma require greater attention to their age and comorbidities, whereas those with severe asthma require greater attention to hospitalisation history and drug adherence.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2017-020825","type":"journal-article","created":{"date-parts":[[2018,3,22]],"date-time":"2018-03-22T06:21:17Z","timestamp":1521699677000},"page":"e020825","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":62,"title":["Risk factors of asthma exacerbation based on asthma severity: a nationwide population-based observational study in South Korea"],"prefix":"10.1136","volume":"8","author":[{"given":"Hye-Rim","family":"Kang","sequence":"first","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hyun Jin","family":"Song","sequence":"additional","affiliation":[{"name":"College of Pharmacy, University of Florida, Gainesville, Florida, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jin Hyun","family":"Nam","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, Medical University of South Carolina, Charleston, South Carolina, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sung-Hyun","family":"Hong","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"So-Young","family":"Yang","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SangEun","family":"Ju","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sang Won","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tae-Bum","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hye-Lin","family":"Kim","sequence":"additional","affiliation":[{"name":"College of Pharmacy, Sahmyook University, Seoul, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eui-Kyung","family":"Lee","sequence":"additional","affiliation":[{"name":"School of Pharmacy, Sungkyunkwan University, Suwon, Korea"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2018,3,22]]},"reference":[{"key":"2025121403180776000_8.3.e020825.1","unstructured":"World Health Organization. Asthma. http:\/\/www.who.int\/mediacentre\/factsheets\/fs307\/en\/ (accessed 3 Nov 2017)."},{"key":"2025121403180776000_8.3.e020825.2","doi-asserted-by":"publisher","DOI":"10.1159\/000338998"},{"key":"2025121403180776000_8.3.e020825.3","doi-asserted-by":"crossref","first-page":"454","DOI":"10.1111\/resp.12930","article-title":"Association between asthma control and asthma cost: Results from a longitudinal study in a primary care setting","volume":"22","author":"Nguyen","year":"2017","journal-title":"Respirology"},{"key":"2025121403180776000_8.3.e020825.4","unstructured":"Global Initiative for Asthma. Global strategy for asthma management and prevention 2017 http:\/\/www.ginasthma.org (accessed 3 Nov 2017)."},{"key":"2025121403180776000_8.3.e020825.5","unstructured":"OECD. Health at a Glance 2015 Paris. OECD Publishing, 2015. (accessed 3 Nov 2017)."},{"key":"2025121403180776000_8.3.e020825.6","unstructured":"The Global Asthma Network. The Global Asthma Report 2014. Auckland, New Zealand, 2014."},{"key":"2025121403180776000_8.3.e020825.7","unstructured":"Clinical Practice Guidelines. 2007. Expert Panel Report 3: Guidelines for the Diagnosis and Management of Asthma. National Asthma Education and Prevention Program, Third Expert Panel on the Diagnosis and Management of Asthma. Bethesda, MD: National Heart, Lung, and Blood Institute (US). Report No: 07-4051."},{"key":"2025121403180776000_8.3.e020825.8","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0112844","article-title":"Risk factors for asthma-related healthcare use: longitudinal analysis using the NHI claims database in a Korean asthma cohort","volume":"9","author":"Lee","year":"2014","journal-title":"PLoS One"},{"key":"2025121403180776000_8.3.e020825.9","doi-asserted-by":"crossref","first-page":"120","DOI":"10.1016\/j.jaip.2015.08.003","article-title":"Utilization and costs of severe uncontrolled asthma in a managed-care setting","volume":"4","author":"Zeiger","year":"2016","journal-title":"J Allergy Clin Immunol"},{"key":"2025121403180776000_8.3.e020825.10","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00075614"},{"key":"2025121403180776000_8.3.e020825.11","doi-asserted-by":"publisher","DOI":"10.3109\/02770903.2013.799687"},{"key":"2025121403180776000_8.3.e020825.12","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1016\/j.clinthera.2017.01.025","article-title":"Health care utilization and direct costs in mild, moderate, and severe adult asthma: a descriptive study using the 2014 South Korean health insurance database","volume":"39","author":"Lee","year":"2017","journal-title":"Clin Ther"},{"key":"2025121403180776000_8.3.e020825.13","first-page":"170","article-title":"Ratio of controller to total asthma medications: determinants of the measure","volume":"16","author":"Broder","year":"2010","journal-title":"Am J Manag Care"},{"key":"2025121403180776000_8.3.e020825.14","first-page":"775","article-title":"Impacts of coexisting bronchial asthma on severe exacerbations in mild-to-moderate COPD: results from a national database","volume":"11","author":"Lee","year":"2016","journal-title":"Int J Chron Obstruct Pulmon Dis"},{"key":"2025121403180776000_8.3.e020825.15","first-page":"e15","article-title":"Cohort profile: the National Health Insurance service-national sample cohort (NHIS-NSC), South Korea","volume":"46","author":"Lee","year":"2017","journal-title":"Int J Epidemiol"},{"key":"2025121403180776000_8.3.e020825.16","unstructured":"National Health Insurance Sharing Service, Sample cohort DB. https:\/\/nhiss.nhis.or.kr\/bd\/ab\/bdaba022eng.do# (accessed 4 Nov 2017)."},{"key":"2025121403180776000_8.3.e020825.17","unstructured":"Global Initiative for Asthma. Diagnosis and initial treatment of Asthma, COPD and Asthma-COPD overlap. 2017 http:\/\/ginasthma.org (accessed 6 Jan 2018)."},{"key":"2025121403180776000_8.3.e020825.18","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/rr37","article-title":"Risk factors for hospitalization among adults with asthma: the influence of sociodemographic factors and asthma severity","volume":"2","author":"Eisner","year":"2001","journal-title":"Respir Res"},{"key":"2025121403180776000_8.3.e020825.19","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00121308"},{"key":"2025121403180776000_8.3.e020825.20","doi-asserted-by":"publisher","DOI":"10.1111\/j.1398-9995.2009.02301.x"},{"key":"2025121403180776000_8.3.e020825.21","doi-asserted-by":"publisher","DOI":"10.1097\/PSY.0b013e3182864ee3"},{"key":"2025121403180776000_8.3.e020825.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2005.03.003"},{"key":"2025121403180776000_8.3.e020825.23","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2012.07.053"},{"key":"2025121403180776000_8.3.e020825.24","doi-asserted-by":"publisher","DOI":"10.2165\/11586660-000000000-00000"},{"key":"2025121403180776000_8.3.e020825.25","doi-asserted-by":"publisher","DOI":"10.1345\/aph.1K671"},{"key":"2025121403180776000_8.3.e020825.26","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.12.983"},{"key":"2025121403180776000_8.3.e020825.27","first-page":"650","article-title":"How well do the HEDIS asthma inclusion criteria identify persistent asthma?","volume":"11","author":"Mosen","year":"2005","journal-title":"Am J Manag Care"},{"key":"2025121403180776000_8.3.e020825.28","doi-asserted-by":"crossref","first-page":"3208","DOI":"10.21037\/jtd.2017.08.109","article-title":"Current status of asthma care in South Korea: nationwide the Health Insurance Review and Assessment Service database","volume":"9","author":"Choi","year":"2017","journal-title":"J Thorac Dis"},{"key":"2025121403180776000_8.3.e020825.29","doi-asserted-by":"publisher","DOI":"10.1378\/chest.07-0713"},{"key":"2025121403180776000_8.3.e020825.30","doi-asserted-by":"publisher","DOI":"10.1378\/chest.128.3.1128"},{"key":"2025121403180776000_8.3.e020825.31","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/1465-9921-11-163","article-title":"Multi-symptom asthma is closely related to nasal blockage, rhinorrhea and symptoms of chronic rhinosinusitis-evidence from the West Sweden Asthma Study","volume":"11","author":"L\u00f6tvall","year":"2010","journal-title":"Respir Res"},{"key":"2025121403180776000_8.3.e020825.32","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2014-007435","article-title":"Multicentre observational study of adults with asthma exacerbations: who are the frequent users of the emergency department in Japan?","volume":"5","author":"Watase","year":"2015","journal-title":"BMJ Open"},{"key":"2025121403180776000_8.3.e020825.33","doi-asserted-by":"publisher","DOI":"10.1183\/09031936.00202013"},{"key":"2025121403180776000_8.3.e020825.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.rmed.2005.02.013"},{"key":"2025121403180776000_8.3.e020825.35","first-page":"Cd002982","article-title":"Psychological interventions for adults with asthma","volume":"1","author":"Yorke","year":"2006","journal-title":"Cochrane Database Syst Rev"},{"key":"2025121403180776000_8.3.e020825.36","doi-asserted-by":"crossref","unstructured":"Centers for Disease Control and Prevention. Most recent asthma data. 2017 https:\/\/www.cdc.gov\/asthma\/most_recent_data.htm#modalIdString_CDCTable_0 (accessed 1 Jan 2018).","DOI":"10.1007\/978-3-319-32001-4_258-1"},{"key":"2025121403180776000_8.3.e020825.37","doi-asserted-by":"publisher","DOI":"10.1258\/jrsm.2009.090348"},{"key":"2025121403180776000_8.3.e020825.38","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2006.21.2.181"},{"key":"2025121403180776000_8.3.e020825.39","doi-asserted-by":"publisher","DOI":"10.1081\/JAS-120017212"},{"key":"2025121403180776000_8.3.e020825.40","doi-asserted-by":"publisher","DOI":"10.4187\/respcare.03200"},{"key":"2025121403180776000_8.3.e020825.41","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1016\/j.jaip.2014.06.012","article-title":"A multicenter observational study of US adults with acute asthma: who are the frequent users of the emergency department?","volume":"2","author":"Hasegawa","year":"2014","journal-title":"J Allergy Clin Immunol Pract"},{"key":"2025121403180776000_8.3.e020825.42","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2011.09.011"},{"key":"2025121403180776000_8.3.e020825.43","doi-asserted-by":"publisher","DOI":"10.1016\/S1081-1206(10)60808-3"},{"key":"2025121403180776000_8.3.e020825.44","doi-asserted-by":"publisher","DOI":"10.1080\/02770900802627294"},{"key":"2025121403180776000_8.3.e020825.45","doi-asserted-by":"publisher","DOI":"10.1002\/1099-1557(200007\/08)9:4<293::AID-PDS502>3.0.CO;2-S"},{"key":"2025121403180776000_8.3.e020825.46","doi-asserted-by":"publisher","DOI":"10.4070\/kcj.2012.42.1.10"},{"key":"2025121403180776000_8.3.e020825.47","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2013.37.4.233"}],"container-title":["BMJ Open"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bmjopen-2017-020825","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T11:18:17Z","timestamp":1765711097000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmjopen.bmj.com\/lookup\/doi\/10.1136\/bmjopen-2017-020825"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,3]]},"references-count":47,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2018,3,22]]},"published-print":{"date-parts":[[2018,3]]}},"alternative-id":["10.1136\/bmjopen-2017-020825"],"URL":"https:\/\/doi.org\/10.1136\/bmjopen-2017-020825","relation":{},"ISSN":["2044-6055","2044-6055"],"issn-type":[{"value":"2044-6055","type":"print"},{"value":"2044-6055","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,3]]}}}