The relationship between real-world inhaled corticosteroids adherence and asthma outcomes: a multilevel approach

Respiratory Effectiveness Group’s Adherence Working Group

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

BACKGROUND: Low inhaled corticosteroids (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, persistence). Studies rarely examine reciprocal influences.

OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes across two 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 had ≥3 years continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, ≥6 years, ≥2 ICS and/or short-acting beta-agonists (SABA) prescriptions each follow-up year, no long-acting beta-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, no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between two successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for socio-demographic 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 COPD diagnosis and <4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval, and SABA 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.

Original languageEnglish
JournalThe journal of allergy and clinical immunology. In practice
Early online date18 Sept 2019
Publication statusE-pub ahead of print - 18 Sept 2019


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