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Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma

Papi, Alberto; Ryan, Dermot; Soriano, Joan B.; Chrystyn, Henry; Bjermer, Leif LU ; Rodríguez-Roisin, Roberto; Dolovich, Myrna B.; Harris, Mark; Wood, Lucy and Batsiou, Maria, et al. (2018) In Journal of Allergy and Clinical Immunology: In Practice 6(6). p.3-1998
Abstract

Background: Patients with asthma and elevated blood eosinophils are at increased risk of severe exacerbations. Management of these patients should consider nonadherence to inhaled corticosteroid (ICS) therapy as a factor for increased exacerbation risk. Objective: The objective of this study was to investigate whether poor adherence to ICS therapy explains the occurrence of asthma exacerbations in patients with elevated blood eosinophil levels. Methods: This historical cohort study identified patients within the Optimum Patient Care Research Database, aged 18 years or more, at Global Initiative for Asthma step 3 or 4, with 2 or more ICS prescriptions during the year before the clinical review. Patient characteristics and adherence... (More)

Background: Patients with asthma and elevated blood eosinophils are at increased risk of severe exacerbations. Management of these patients should consider nonadherence to inhaled corticosteroid (ICS) therapy as a factor for increased exacerbation risk. Objective: The objective of this study was to investigate whether poor adherence to ICS therapy explains the occurrence of asthma exacerbations in patients with elevated blood eosinophil levels. Methods: This historical cohort study identified patients within the Optimum Patient Care Research Database, aged 18 years or more, at Global Initiative for Asthma step 3 or 4, with 2 or more ICS prescriptions during the year before the clinical review. Patient characteristics and adherence (based on prescription refills and patient self-report) for ICS therapy were analyzed for those with elevated (>400 cells/μL) or normal (≤400 cells/μL) blood eosinophils. Results: We studied 7195 patients (66% female, mean age 60 years) with median eosinophil count of 200 cells/μL and found 81% to be not fully adherent to ICS therapy. A total of 1031 patients (14%) had elevated blood eosinophil counts (58% female, mean age 60 years), 83% of whom were not fully adherent to ICS. An increased proportion of adherent patients in the elevated blood eosinophil group had 2 or more exacerbations (14.0% vs 7.2%; P =.003) and uncontrolled asthma (73% vs 60.8%; P =.004) as compared with non–fully adherent patients. Conclusions: Approximately 1 in 7 patients had elevated eosinophils. Adherence to ICS therapy was not associated with decreased exacerbations for these patients. Additional therapy should be considered for these patients, such as biologics, which have been previously shown to improve control in severe uncontrolled eosinophilic asthma.

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publication status
published
subject
keywords
Adherence, Asthma control, Asthma exacerbations, Eosinophils, Inhaled corticosteroids, Severe asthma
in
Journal of Allergy and Clinical Immunology: In Practice
volume
6
issue
6
pages
3 - 1998
publisher
Elsevier
external identifiers
  • scopus:85046625981
ISSN
2213-2198
DOI
10.1016/j.jaip.2018.03.008
language
English
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yes
id
96e43b6d-316e-4a50-9088-f1b0ccb2c9df
date added to LUP
2018-05-25 14:43:51
date last changed
2019-08-14 04:17:19
@article{96e43b6d-316e-4a50-9088-f1b0ccb2c9df,
  abstract     = {<p>Background: Patients with asthma and elevated blood eosinophils are at increased risk of severe exacerbations. Management of these patients should consider nonadherence to inhaled corticosteroid (ICS) therapy as a factor for increased exacerbation risk. Objective: The objective of this study was to investigate whether poor adherence to ICS therapy explains the occurrence of asthma exacerbations in patients with elevated blood eosinophil levels. Methods: This historical cohort study identified patients within the Optimum Patient Care Research Database, aged 18 years or more, at Global Initiative for Asthma step 3 or 4, with 2 or more ICS prescriptions during the year before the clinical review. Patient characteristics and adherence (based on prescription refills and patient self-report) for ICS therapy were analyzed for those with elevated (&gt;400 cells/μL) or normal (≤400 cells/μL) blood eosinophils. Results: We studied 7195 patients (66% female, mean age 60 years) with median eosinophil count of 200 cells/μL and found 81% to be not fully adherent to ICS therapy. A total of 1031 patients (14%) had elevated blood eosinophil counts (58% female, mean age 60 years), 83% of whom were not fully adherent to ICS. An increased proportion of adherent patients in the elevated blood eosinophil group had 2 or more exacerbations (14.0% vs 7.2%; P =.003) and uncontrolled asthma (73% vs 60.8%; P =.004) as compared with non–fully adherent patients. Conclusions: Approximately 1 in 7 patients had elevated eosinophils. Adherence to ICS therapy was not associated with decreased exacerbations for these patients. Additional therapy should be considered for these patients, such as biologics, which have been previously shown to improve control in severe uncontrolled eosinophilic asthma.</p>},
  author       = {Papi, Alberto and Ryan, Dermot and Soriano, Joan B. and Chrystyn, Henry and Bjermer, Leif and Rodríguez-Roisin, Roberto and Dolovich, Myrna B. and Harris, Mark and Wood, Lucy and Batsiou, Maria and Thornhill, Susannah I. and Price, David B.},
  issn         = {2213-2198},
  keyword      = {Adherence,Asthma control,Asthma exacerbations,Eosinophils,Inhaled corticosteroids,Severe asthma},
  language     = {eng},
  number       = {6},
  pages        = {3--1998},
  publisher    = {Elsevier},
  series       = {Journal of Allergy and Clinical Immunology: In Practice},
  title        = {Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma},
  url          = {http://dx.doi.org/10.1016/j.jaip.2018.03.008},
  volume       = {6},
  year         = {2018},
}