D2.533 - Characterizing Elderly Asthma Hospitalizations: Insights into Treatment Gaps and Outcomes; A Real‑World Study Using the MIMIC‑IV Dataset

Older adults with asthma are under-represented in clinical trials despite high hospitalization rates and multimorbidity. Real-world data on medication use across the care continuum and associated hospital outcomes in this population remain limited.

We conducted a retrospective cohort study using the MIMIC-IV (v3.1) dataset. Patients aged ≥65 years admitted with a primary ICD-10 diagnosis of asthma (J45.*) were included. Pre-admission medications were identified from medication reconciliation records, inpatient therapies from prescribing and administration data, and discharge medications from discharge prescriptions. Controller therapy was defined as inhaled corticosteroids (ICS), ICS/long-acting β-agonist (LABA), leukotriene receptor antagonists, or long-acting muscarinic antagonists. Outcomes included hospital length of stay (LOS), ICU admission and 30-day mortality. Results were summarized descriptively and stratified by controller therapy status.

We identified 185 admissions (median age 73 years [IQR 68–79]; 69.2% female). Prior to admission, 45.4% were receiving controller therapy, 7.0% relied on rescue-only treatment, 15.7% were on chronic oral corticosteroids. During hospitalization, 88.1% received systemic corticosteroids, 82.2% bronchodilators, and 35.7% antibiotics. Median hospital LOS was 2.89 days (IQR 1.37–6.92); 24.9% required ICU care (median ICU LOS 6.86 days [IQR 2.62–12.6]). Patients not on pre-admission controller therapy had longer median LOS (4.77 vs 2.09 days) and higher ICU admission rates (39.6% vs 7.1%) compared with those on controllers.

Elderly patients hospitalized for asthma represent a vulnerable population with high multimorbidity, frequent ICU use, and low uptake of controller therapy. These results reveal critical gaps in chronic asthma management and care transitions that should be prioritized for improvement.