Robert S Zeiger1, Michael Schatz2, Qiaowu Li2, Wansu Chen2, Deepak B Khatry3, Trung N Tran4. 1. Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org. 2. Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. 3. Statistical Sciences, MedImmune LLC, Gaithersburg, Md. 4. Observational Research Center, AstraZeneca, Gaithersburg, Md.
Abstract
BACKGROUND: Chronic oral corticosteroid (C-OCS) use in asthma is an indicator of disease severity, but its risk factors are largely unknown. OBJECTIVE: To describe patient characteristics and disease burden associated with C-OCS use by adults with persistent asthma. METHODS: We identified 9546 patients aged 18 to 64 years in a large managed care organization who met the Healthcare Effectiveness Data and Information Set 2-year criteria (2009-2010) for persistent asthma. A subgroup had blood eosinophil counts. We calculated cumulative OCS dispensed per patient in 2010 and examined the distribution of disease characteristics by average daily amounts of OCS dispensed. C-OCS use was defined as 2.5 mg/d or more. Baseline factors (2010) associated with C-OCS use during follow-up (2011) were investigated by multivariable Poisson regression. RESULTS: At baseline, 782 (8.2%) patients were C-OCS users. Compared with patients who received no or less than 2.5 mg/d OCS, C-OCS users were older and more often female and ethnic minorities; and had more comorbidities, asthma specialist care, greater step-care level, controllers, asthma exacerbations, and greater blood eosinophil counts (all P < .01). Baseline factors significantly associated with C-OCS use in the follow-up year included (1) demographic characteristics: older age, females, blacks versus whites, and whites versus others/unknown ethnicities; (2) disease burden: more asthma emergency department or hospitalization visits, greater step-care level, excessive short-acting β2-agonist dispensed, theophylline use, asthma specialist care, and nasal polyposis; (3) greater blood eosinophil counts; and (4) most strongly, C-OCS use. CONCLUSIONS: C-OCS use was associated with more asthma burden, comorbidities, and greater blood eosinophil counts. Prior C-OCS use was the strongest predictor of future C-OCS use.
BACKGROUND: Chronic oral corticosteroid (C-OCS) use in asthma is an indicator of disease severity, but its risk factors are largely unknown. OBJECTIVE: To describe patient characteristics and disease burden associated with C-OCS use by adults with persistent asthma. METHODS: We identified 9546 patients aged 18 to 64 years in a large managed care organization who met the Healthcare Effectiveness Data and Information Set 2-year criteria (2009-2010) for persistent asthma. A subgroup had blood eosinophil counts. We calculated cumulative OCS dispensed per patient in 2010 and examined the distribution of disease characteristics by average daily amounts of OCS dispensed. C-OCS use was defined as 2.5 mg/d or more. Baseline factors (2010) associated with C-OCS use during follow-up (2011) were investigated by multivariable Poisson regression. RESULTS: At baseline, 782 (8.2%) patients were C-OCS users. Compared with patients who received no or less than 2.5 mg/d OCS, C-OCS users were older and more often female and ethnic minorities; and had more comorbidities, asthma specialist care, greater step-care level, controllers, asthma exacerbations, and greater blood eosinophil counts (all P < .01). Baseline factors significantly associated with C-OCS use in the follow-up year included (1) demographic characteristics: older age, females, blacks versus whites, and whites versus others/unknown ethnicities; (2) disease burden: more asthma emergency department or hospitalization visits, greater step-care level, excessive short-acting β2-agonist dispensed, theophylline use, asthma specialist care, and nasal polyposis; (3) greater blood eosinophil counts; and (4) most strongly, C-OCS use. CONCLUSIONS: C-OCS use was associated with more asthma burden, comorbidities, and greater blood eosinophil counts. Prior C-OCS use was the strongest predictor of future C-OCS use.
Authors: John Blakey; Li Ping Chung; Vanessa M McDonald; Laurence Ruane; John Gornall; Chris Barton; Sinthia Bosnic-Anticevich; John Harrington; Mark Hew; Anne E Holland; Trudy Hopkins; Lata Jayaram; Helen Reddel; John W Upham; Peter G Gibson; Philip Bardin Journal: Respirology Date: 2021-09-29 Impact factor: 6.175
Authors: Giorgio Walter Canonica; Giorgio Lorenzo Colombo; Giacomo Matteo Bruno; Sergio Di Matteo; Chiara Martinotti; Francesco Blasi; Caterina Bucca; Nunzio Crimi; Pierluigi Paggiaro; Girolamo Pelaia; Giovanni Passalaqua; Gianenrico Senna; Enrico Heffler Journal: World Allergy Organ J Date: 2019-01-26 Impact factor: 4.084
Authors: Trung N Tran; Elizabeth King; Rajiv Sarkar; Cassandra Nan; Annalisa Rubino; Caroline O'Leary; Ruvimbo Muzwidzwa; Laura Belton; Jennifer K Quint Journal: Eur Respir J Date: 2020-06-04 Impact factor: 16.671
Authors: Mohsen Sadatsafavi; Amir Khakban; Hamid Tavakoli; Solmaz Ehteshami-Afshar; Larry D Lynd; J Mark FitzGerald Journal: Respir Res Date: 2021-04-09
Authors: Eugene R Bleecker; Andrew N Menzies-Gow; David B Price; Arnaud Bourdin; Stephen Sweet; Amber L Martin; Marianna Alacqua; Trung N Tran Journal: Am J Respir Crit Care Med Date: 2020-02-01 Impact factor: 21.405
Authors: Victoria S Benson; Sylvia Hartl; Neil Barnes; Nicholas Galwey; Melissa K Van Dyke; Namhee Kwon Journal: Eur Respir J Date: 2022-01-13 Impact factor: 16.671