Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France

Belhassen, Manon; Nolin, M.; Nibber, Anjan; Ginoux, M.; Devouassoux, Gilles; Ganse, Éric Van

doi:10.1016/j.jaip.2019.02.025

Cited by 12 publications

(16 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Interestingly, these trials were designed very similarly and were based on primary outcomes nearly identical to those developed for registration studies with ICSs in the 1970s [3]. Surprisingly, in France as in other countries, OCS use is still increasing [12,17]. Chronic airway diseases are by far the most common reason for using OCSs in the short, middle and long term [35].…”

Section: History Of Ocs In Severe Asthmamentioning

confidence: 99%

“…Nonetheless, surveys reveal that OCSs are still widely used as controllers in about 20% of patients with severe asthma and, most frequently, as rescue medications through repeated bursts using doses suspected to be as toxic as regular use of lower doses, and also in children with severe and nonsevere asthma [10][11][12][13]. Very few prospective and long-term longitudinal studies are available, but it was suggested that this strategy exposed patients to an increased risk of death [14][15][16][17][18]. Side-effects of OCSs are well known to the pulmonologist and involve virtually all organs.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

Self Cite

View full text Add to dashboard Cite

Options to achieve oral corticosteroid (OCS)-sparing have been triggering increasing interest since the 1970s because of the side-effects of OCSs, and this has now become achievable with biologics. The Société de Pneumologie de Langue Française workshop on OCSs aimed to conduct a comprehensive review of the basics for OCS use in asthma and issue key research questions. Pharmacology and definition of regular use were reviewed by the first working group (WG1). WG2 examined whether regular OCS use is associated with T2 endotype. WG3 reported on the specificities of the paediatric area. Key “research statement proposals” were suggested by WG4. It was found that the benefits of regular OCS use in asthma outside episodes of exacerbations are poorly supported by the existing evidence. However, complete OCS elimination couldn’t be achieved in any available studies for all patients and the panel felt that it was too early to conclude that regular OCS use could be declared criminal. Repeated or prolonged need for OCS beyond 1 g·year−1 should indicate the need for referral to secondary/tertiary care. A strategic sequential plan aiming at reducing overall exposure to OCS in severe asthma was then held as a conclusion of the workshop.

show abstract

Section: History Of Ocs In Severe Asthmamentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

How can we minimise the use of regular oral corticosteroids in asthma?

et al. 2020

Self Cite

View full text Add to dashboard Cite

show abstract

“…For bronchodilators in single inhalers use, the data reveal that the majority of LABAs uses tended to be regular (>75%), and regular use increased the odds of exacerbations with 29% compared to periods of non-use, in agreement with available evidence 20 . However, the number of patients using single LABA inhalers decreases fastly, as shown by recent studies 21 , precluding more robust findings from this study population. Nonetheless, the use of LABAs in monotherapy is contra-indicated in asthma, and the identification of patients still relying on this therapy suggests that additional efforts are needed to raise prescribers' awareness of the risks related to this use.…”

Section: Baseline Sample Characteristicsmentioning

confidence: 76%

“…Significant changes in LABA use in favor of FDCs at the expense of single LABA and ICS inhalers have indeed been observed recently. In France, a 2.4-fold decrease in the number of users of LABA monotherapies was identified between 2006 and 2016: from 4.1% to 1.7%21 . In the UK, the prevalence of single LABA use also decreased sharply from 11.3% to 5.4% between 2007 and 20119 .…”

mentioning

confidence: 99%

Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort

Ganse

Texier²,

Dima

et al. 2020

Annals of Allergy, Asthma & Immunology

Self Cite

View full text Add to dashboard Cite

Background. In asthma, short-and long-acting β-agonists (SABAs and LABAs) should be used together with inhaled corticosteroids (ICS), and regular use is inappropriate. Objective. To assess the relationship between patterns of use of therapy and asthma exacerbations (AEx). Methods. Asthmatic patients (6-40 years) were enrolled in France and the United Kingdom. Prescribing data, Computer-Assisted Telephone Interviews (CATIs), and text messages assessed medication use and AEx over a maximum period of 24 months. Generalized linear mixed models provided AEx risks associated with therapy. Results. Among the 908 patients (median age: 20.0 years, 46.6% women, 24.5% children) answering a total of 4,248 CATIs over 486 (±235) days, regular (i.e. daily) use was more frequent for single LABAs and Fixed Dose Combinations (FDCs) than for single ICS (75.6%, 70.1%, and 65.4% of investigated periods of use, respectively). Regular (i.e. daily or almost daily) SABA use was observed for 21.1% of periods of use. Altogether, 265 patients (29.2%) experienced ≥1 AEx. ORs for AEx risk related to regular vs. no use of FDCs, single ICS, and single LABAs were 0.98 (95% CI=[0.73-1.33]), 0.90 (95% CI=[0.61-1.33]), and 1.29 (95% CI=[0.76-2.17]), respectively, after adjustment for cotherapy, sociodemographic, and disease characteristics. The OR was 2.09 (95% CI=[1.36-3.21]) in regular SABA users. Conclusion. ICS and FDCs were often used intermittently whereas SABAs and LABAs could be used regularly, and exacerbations were frequent. Compared to non-users, the risk of exacerbation increased moderately under regular use of single LABAs, while it doubled, significantly, in regular SABA users, likely in relationship with poor overall asthma control.

show abstract

“…Other studies have found trends of increased OCS use during the last decades. This includes a French study on national claim data among 18‐ to 40‐year‐old asthma medication users 31 and a study on electronic healthcare records from the United Kingdom 32 . The latter study demonstrated that the proportion of asthma patients in the United Kingdom receiving at least three courses of OCS per year doubled from 1% to 2% in the period of 2006–2017.…”

Section: Discussionmentioning

confidence: 99%

Changes in oral corticosteroid use in asthma treatment—A 20‐year Danish nationwide drug utilisation study

Skov

Henriksen

Madsen³

et al. 2021

Basic Clin Pharma Tox

View full text Add to dashboard Cite

Oral corticosteroids (OCS) are used in asthma management but can cause serious adverse effects. We aimed to investigate the usage trends in a nationwide asthma cohort in Denmark from 1999 to 2018. Using national registers, we identified young adults (18–45 years) with two or more asthma drug collections within 12 months since the age of 15 years as indicative of active asthma. OCS exposure level was stratified as high use (≥5 mg prednisolone/day/year) and low use (<5 mg/day/year). Lorenz curves were computed to illustrate potential skewness of consumption among the OCS users. We identified 318 950 individuals with a median age of 29 years (IQR 20–38 years) whereof 57% were women. The 1‐year prevalence of OCS users was stable at 4.8% (median, IQR 4.7%–4.8%), but with nearly 40% decrease in high‐users from 0.54% in 1999 to 0.33% in 2018. The median annual exposure decreased from 500 mg/year (1999) to 250 mg/year (2018). We found a substantial skewness in the distribution of OCS usage with 10% of users accounting for almost 50% of all OCS use. The prevalence of OCS users among young adults with active asthma has been relatively stable from 1999 to 2018, but with a decreasing prevalence of high‐users and annual consumption.

show abstract

Changes in Persistent Asthma Care and Outcomes From 2006 to 2016 in France

Cited by 12 publications

References 29 publications

How can we minimise the use of regular oral corticosteroids in asthma?

How can we minimise the use of regular oral corticosteroids in asthma?

Effects of short- and long-acting beta-agonists on asthma exacerbations: a prospective cohort

Changes in oral corticosteroid use in asthma treatment—A 20‐year Danish nationwide drug utilisation study

Contact Info

Product

Resources

About