Marcia Vervloet1, Liset van Dijk2, Peter Spreeuwenberg3, David Price4, Alison Chisholm5, Eric Van Ganse6, Hilary Pinnock7, Cynthia S Rand8, Michelle N Eakin8, Tjard Schermer9, Patrick C Souverein10, Alexandra L Dima11. 1. Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands. Electronic address: M.Vervloet@nivel.nl. 2. Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of PharmacoTherapy, -Epidemiology & -Economics (PTEE), Groningen Research Institute of Pharmacy, Faculty of Mathematics and Natural Sciences, University of Groningen, Groningen, the Netherlands. 3. Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands. 4. Observational and Pragmatic Research Institute, Singapore, Singapore; Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom. 5. Respiratory Effectiveness Group, Cambridge, United Kingdom. 6. Health Services and Performance Research (HESPER), Claude Bernard University, Lyon, France; Pharmaco Epidemiology Lyon (PELyon), Lyon, France; Respiratory Medicine, Croix-Rousse University Hospital, Lyon, France. 7. Asthma UK Centre for Applied Research, Allergy and Respiratory Research Group, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, United Kingdom. 8. Division of Pulmonary and Critical Care Medicine, Johns Hopkins University, Baltimore, Md. 9. Nivel, Netherlands Institute for Health Services Research, Utrecht, the Netherlands; Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, the Netherlands. 10. Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences, Utrecht University, Utrecht, the Netherlands. 11. Health Services and Performance Research (HESPER), Claude Bernard University, Lyon, France.
Abstract
BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences. OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence. METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics. RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation. CONCLUSIONS: Patients may adapt their ICS use to their current needs without this impacting later RDAC.
BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences. OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence. METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics. RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation. CONCLUSIONS:Patients may adapt their ICS use to their current needs without this impacting later RDAC.
Authors: Nikolaos G Papadopoulos; Alexander G Mathioudakis; Adnan Custovic; Antoine Deschildre; Wanda Phipatanakul; Gary Wong; Paraskevi Xepapadaki; Rola Abou-Taam; Ioana Agache; Jose A Castro-Rodriguez; Zhimin Chen; Pierrick Cros; Jean-Christophe Dubus; Zeinab Awad El-Sayed; Rasha El-Owaidy; Wojciech Feleszko; Vincenzo Fierro; Alessandro Fiocchi; Luis Garcia-Marcos; Anne Goh; Elham M Hossny; Yunuen R Huerta Villalobos; Tuomas Jartti; Pascal Le Roux; Julia Levina; Aida Inés López García; Ángel Mazón Ramos; Mário Morais-Almeida; Clare Murray; Karthik Nagaraju; Major K Nagaraju; Elsy Maureen Navarrete Rodriguez; Leyla Namazova-Baranova; Antonio Nieto Garcia; Cesar Fireth Pozo Beltrán; Thanaporn Ratchataswan; Daniela Rivero Yeverino; Eréndira Rodríguez Zagal; Cyril E Schweitzer; Marleena Tulkki; Katarzyna Wasilczuk; Dan Xu Journal: Allergy Date: 2021-03-24 Impact factor: 14.710