T. Tuuponen

Survival and Cause of Death among Elderly Chronic Obstructive Pulmonary Disease Patients after First Admission to Hospital

Those patients with chronic obstructive pulmonary disease (COPD) who require hospital treatment are severely ill. We have studied the survival and cause of death among COPD patients in Finland after their first admission to hospital due to COPD. COPD-related treatment periods in all hospitals during 1972-1992 were collected from the national discharge register, and a subgroup was defined consisting of 2,237 patients aged 65-69 years who had their first admission during 1986-1990. Survival and causes of death were analysed for this group using the data contained in the national mortality statistics. The mortality data were recorded up to the end of 1993. By the end of 1993, 1,070 persons (48%) in the study group had died. The median survival time was 5.71 years (95% CI 5.27-6.15). Female COPD patients had a more favourable prognosis than males. COPD had been certified as the main cause of death for 33.3% of the women and 29.4% of the men. The proportion of COPD as main cause of death increased with an increasing number of treatment periods prior to death. In conclusion, the first hospital admission for COPD indicates a poor prognosis. A high incidence of pulmonary cancer contributes to the poor outcome in the case of men. COPD is obviously underrated on death certificates as the cause of death among COPD patients.

Seasonal variation in childhood asthma hospitalisations in Finland, 1972–1992

Abstract All hospital treatment periods caused by asthma in children under 15 years in Finland during 1972–1992 were examined. The data were obtained from the Hospital Discharge Register, covering all hospitalisations in Finland. A total of 59,624 asthma related treatment periods were recorded. The monthly variation in hospitalisations peaked in May (35.6% above the trend) and in autumn and early winter (41.3% above the trend in October), whereas the monthly variations were low in late winter and in summer. The overall profile of seasonal variation was similar in both sexes, although admissions were lower for boys than for girls in winter and higher in autumn. The average monthly deviation was highest in the age group 0–4 years in May, 42.8% above the trend, and highest in the age group 5–9 years in October, 53.9% above the trend. Closer examination of the seasonal variation gives indirect information on possible trigger factors for acute asthma. Conclusion A clear seasonal variation could be obser ved in childhood asthma hospital admissions, together with age and sex-related differences in this seasonality. Preventive treatment for asthma should be used effectively in order to avoid acute attacks leading to hospitalisation in children who are allergic to birch pollen and also at times of viral respiratory infections.

Bronchiectasis in Finland: trends in hospital treatment

The incidence of bronchiectasis has probably declined in developed countries in recent years, but no reliable statistical data on this are available. The present paper describes the use made of hospital services by bronchiectatic patients in Finland. Data on a total of 12,539 treatment periods for bronchiectasis that had occurred between 1972 and 1992 were collected from the discharge register maintained by the National Research and Development Centre for Welfare and Health (diagnosis 518 in the International Classification of Diseases up to 1986, and 494 from 1987 onwards). The number of admissions, new occurrences of bronchiectasis and days in hospital were calculated by sex and age in relation to the total population at the end of each year. There were 143 and 87 admissions per million inhabitants in 1972 and 1992, respectively. The admissions, new occurrences and the days in hospital all decreased, at annual rates of 1.3, 4.2 and 5.7%, respectively. Thus, where the number of new occurrences was 50 per million persons in 1977, it was 27 per million in 1992. In summary, bronchiectasis-related hospital treatment declined markedly between 1972 and 1992. Trend is attributed to effective treatment of pulmonary infections and the reduction in tuberculosis.

Survival experience of the population needing hospital treatment for asthma or COPD at age 50–54 years

The aim was to evaluate the differences of mortality among asthma and COPD patients on the basis of the first period of hospitalization of these diseases. A total of 576,916 treatment periods for asthma and COPD between 1972 and 1992 were identified in the discharge register maintained by the National Research and Development Centre for Welfare and Health. Patients aged 50-54 years first treated in hospital in 1977 or later were analysed. There were 6655 new asthma patients of this age, 2727 new COPD patients and 701 new patients in a mixed group (with both diagnoses). Mortality up to the end of 1993 was analysed based on mortality and cause of death data provided by the Central Statistical Office of Finland. Estimated cumulative survival after 10 yr was higher among the asthma patients (83.5% for men and 93.2% for women) and lower among the COPD patients (60.1% and 78.0%) and in the mixed group (62.5% and 74.4%). The main cause of death among the asthmatics was asthma in 12.1% of cases, that among the COPD patients was COPD in 22.1% of cases and that in the mixed group was one or other of these diseases in 39.1% of cases. The prognosis for COPD patients aged 50-54 years requiring hospital treatment is poor. Combination of the data available from the cause of death and hospital discharge registers indicates that obstructive pulmonary diseases may well be of more significance from a public health point of view than the mortality statistics would lead us to believe. The very first hospitalization for COPD calls for a thorough evaluation of the prospects for active treatment and prevention.

Hospital admissions of asthmatics by age and sex

Asthma‐related hospital admissions and the occurrence of new admissions were studied by age and sex in order to find the groups of asthmatics with high hospital admission rates. Data from the Finnish discharge register for 1972–92 were used to analyze the number of hospital admissions caused by asthma (defined in the International Clussification of Diseases, 8th and 9th revisions, code 493) and occurrence of new asthma admissions between 1983 and 1992. A total of 192195 asthma‐induced treatment periods were identified, 91 223 for males and 100972 for females. Boys were admitted twice as often as girls at the age of 1 year (11.2 in comparison with 5.9 admissions per 1000 per year), whereas the admission rate was consistently higher among women 25–55 years of age. The highest asthma admission rate among the elderly was at age 73 for men (10.3 per 1000) and 75 for women (9.5 per 1000). Occurrences of new asthma admissions were most frequent at the age of 1 year (5.3 per 1000 for boys and 2.9 per 1000 for girls) and remained constant among those aged 50–80 years. Asthma is not only a disease of childhood and adolescence. The number of middle‐aged and elderly asthmatics requiring hospitalization is markedly high.

Comorbidity and medication load in adult asthmatics

Objective To examine comorbidity and the medication load among asthmatics. Design A self-administered postal inquiry. Setting A national register-based random sample of 6000 subjects aged 16 years or older entitled to special reimbursement for anti-asthmatic medication in Finland. Subjects A total of 4690 subjects with clinically diagnosed asthma. Main outcome measures Reporting of doctor-diagnosed chronic diseases and the number of prescription medicines used by asthmatics. Results Two-thirds of the subjects (n=2952, 63%) reported other diseases in addition to other chronic pulmonary diseases and allergies. Musculoskeletal and cardiovascular disorders were the most common, increasing with age. Allergies were most frequent among the young asthmatics. Nearly all the subjects (n=4444, 95%) took at least one anti-asthmatic medicine, and two out of every three (n=3051, 65%) received other prescription medicines, most commonly cardiovascular drugs or analgesics. Some 41% (n=1938) of all the asthmatics and as many as 21% of the young adults (n=269) were taking at least five prescription medicines concomitantly. The total medication load increased with age. Conclusion The load of comorbidity and prescribed medication is heavy in adult asthmatics of all ages. Thus asthmatic patients should best be treated by GPs, while pulmonary specialists work as consultants and take care of the most severe cases.

Links between hospital diagnoses of bronchiectasis and asthma

In view of the conflicting notions of the relationship between bronchiectasis and asthma, we have analysed the use of hospital services by bronchiectasis and asthma patients and evaluated the links between these diseases, employing data from the Finnish Hospital Discharge Register of over 21 million hospitalization periods recorded in 1972–92. We conclude that asthma is common in hospitalized bronchiectasis patients and appears to be consequent upon this disease.

HOSPITAL ADMISSIONS FOR CHRONIC OBSTRUCTIVE PULMONARY DISEASE IN THE POPULATION AGED 55 YEARS OR OVER IN FINLAND DURING 1972-1992

Hospital admissions for patients with COPD (chronic obstructive pulmonary disease) as the primary diagnosis for the total Finnish population aged 55 years or over were collected from discharge register from 1972 to 1992. Numbers of admissions and days in hospital by sex and age in relation to total population and the duration of stay in hospital were analysed. A total of 188,570 admissions related to COPD were recorded. There was an average of 17.0 admissions per 1,000 persons per year for men and 2.1 for women. The annual increase in the number of such periods, relative to population, was +1.5% for men (95% confidence interval +0.8 to +2.1%) and +5.1% (+4.0 to +6.2%) for women. A steady upward trend was found in all age groups among women and in the age group 65 years or over among men. The mean number of hospitalisation days increased among women but tended to decrease from the late 1980s onwards among men. The average length of stay decreased from 16.4 days (median: 11 days) in 1972 to 9.6 days (median: 7 days) in 1992. An increase in the need of hospital services was consistent feature among women and older men. Preceding smoking prevalence in Finland, ageing of the population and some institutional factors are the probable aspects behind this trend.

Achievements and shortcomings of Finnish asthma care.

Background: The Finnish National Asthma Programme was launched in 1994. Aim: A postal self-completion questionnaire study was undertaken to evaluate how the guideline is working in the Finnish healthcare system. Methods: A postal inquiry was sent to a random sample of 6,000 subjects aged 16+ years who were entitled to special reimbursement for anti-asthmatic medication and 4,657 subjects with self-reported asthma were included. Results: The subjects comprised 38% men (n=1,781) and 62% women (n=2,876). In all, 62% of all the subjects and 78% of those with severe asthma had visited a doctor on account of asthma in the past 12 months. Some 83% of the respondents had a given physician who was responsible for treating their asthma, and 75% of these were under observation by a primary healthcare physician. Visits to asthma nurses were relatively rare. Inhaled glucocorticoids were used by 83% of the subjects, but short-acting beta-2-agonists were still the most commonly used asthma drug in monotherapy regardless of the severity of asthma. Inhaled glucocorticoids and a short-acting beta-2-agonist was the most frequent combination. Every tenth subject used this combination supplemented by a long-acting beta-2-agonist. Conclusion: Asthma care in Finland seems to be compatible with the national guidelines in terms of continuity and the common use of inhaled glucocorticoids. The primary care sector has adopted the main responsibility for the treatment of asthma. The common use of short-acting beta-2-agonists is an exception to an otherwise positive trend.

Trends in hospitalization among asthmatic children in Finland from 1972 to 1986

Trends in hospitalization among asthmatic children were examined over a period of 15 years on the basis of a hospital discharge register covering all hospitals in Finland. The annual mean population under 15 years of age, 992 994, had a total of 37 965 hospitalization periods on account of asthma during the interval studied. Examination in 5 year are groups showed treatment periods for boys under 5 years to have increased by 1.8% annually relative to the total population (95% confidence interval +0.6–+3.1) and those for girls by 2.2% (95% CI+0.7–+3.7), whereas the changes in the older age groups were insignificant. First admissions decreased annually in all age groups in the case of both boys and girls. The numbers of hospitalization periods due to asthma were significantly higher for boys than for girls. The use of hospital services by asthmatic children was appropriate during the period concerned, which may partly be explained by the fact that child health care is well organized in Finland and the treatment of childhood asthma entirely in the hands of paediatricians.