Multimorbidity in Asthma, Allergic Conditions and COPD Increase Disease Severity, Drug Use and Costs: The Finnish Pharmacy Survey

Abstract

Background: Asthma, allergic conditions, and COPD overlap, but the effect of them and their combinations on disease severity, need for drugs, use of healthcare, and costs is poorly known. Objective: To study how different allergic diseases co-occur in asthma and allergy patients and evaluate the use of medication well as drug and healthcare costs. Methods: Nationwide Allergy Barometer Survey was carried out in the Finnish pharmacies during 1 week in September 2016. Altogether, 956 patients (5–75 years) who purchased asthma or allergy drugs with prescription participated in 351 pharmacies. Results: Of the participants, 78% reported physician-diagnosed asthma, 57% allergic rhinitis, 24% atopic eczema, 21% food allergy, 20% allergic conjunctivitis, 8% anaphylaxis, and 8% COPD. One-third of the patients had at least three conditions, and multimorbidity was common across all age groups. Disease severity increased with the number of coexisting conditions, and asthma severity also with age. Patients with asthma alone used on average 3.8 drugs with the annual costs of EUR 661. This increased to 4.9 drugs and EUR 847 in asthmatics with multimorbidity. For all participants, costs of drugs and healthcare services together during the preceding year were on average EUR 1,214, of which 56% were drug costs. The costs doubled to EUR 2,714 in 65 subjects (7%) who had both asthma and COPD. Conclusions: In asthma and allergy, multimorbidity and polypharmacy are major concerns. Disease severity, drug use, and costs increased with multimorbid conditions. To reduce the burden, allergy management should be better integrated and more comprehensive.

Allergic rhinitis

“…In addition, data from the mobile application MASK-air have identified an extreme pattern of uncontrolled multimorbidity (uncontrolled rhinitis, conjunctivitis and asthma during the same day) 32 . More recent classical epidemiological studies showed that ocular symptoms are more common in polysensitized patients 29 whether they have asthma or do not have asthma 30 , ocular symptoms are associated with the severity of nasal symptoms 33 , ocular symptoms are important to consider in severe asthma 33 and the severity of allergic diseases increases with the number of allergic multimorbidities 34 .…”

“…In this regard, differences between AR alone and AR associated with conjunctivitis were previously known 29 but epidemiological studies using data from mobile applications demonstrated that ocular symptoms are more common in patients with polysensitization 30 , are associated with nasal symptom severity 33 and are important to consider in severe asthma 33 . Moreover, the severity of allergic diseases increases with the number of allergic multimorbidities 34 . This is the first example of a discovery of novel allergic phenotypes using a mobile health application confirmed by classic epidemiological studies.…”

Multimorbidity in asthma, association with allergy, inflammatory markers and symptom burden, results from the Swedish GA2LEN study

“…Many people with asthma also have other comorbidities such as rhinitis and eczema. 1 In previous studies, having more than one allergic disease has been linked to poorer asthma control, a poorer prognosis, breathing-related comorbidities, such as sleep apnoea, 2 and poorer quality of life. 3,4 It is known that allergic sensitization increases the risk of asthma, rhinitis and eczema, 5 but multimorbidity with asthma, rhinitis and eczema can occur both with and without the presence of atopy.…”

Mobile Technology in Allergic Rhinitis: Evolution in Management or Revolution in Health and Care?

“…CDSSs may also be very useful in stratification strategies and in reporting outcomes in clinical trials such as in Allergen Immunotherapy (https://www.ncbi.nlm.nih.gov/pubmed/30955224). (iv) the severity of allergic diseases increases with the number of allergic multimorbidities (75). This is the first time that novel allergic phenotypes have been discovered using an mHealth app and then confirmed by classical epidemiologic studies.…”