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; Rodríguez-Roisin, Roberto; Dolovich, Myrna; Harris, Mark; Wood, Lucy; Batsiou, Maria; Thornhill, Susannah I.; Price, David

doi:10.1016/j.jaip.2018.03.008

Cited by 48 publications

(44 citation statements)

References 43 publications

(45 reference statements)

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“…Specifically, for safety reasons, GINA no longer recommends SABA-only treatment in asthma but recommends that patients using three or more canisters of SABA per year should be assessed due to the associated increased future risk for exacerbations, hospitalization, or mortality [1]. A variety of factors increase the risk of exacerbations; patients may be at risk despite asthma severity, disease symptom control, or treatment adherence [20][21][22].…”

Section: How Did We Get Here?mentioning

confidence: 99%

Effective Asthma Management: Is It Time to Let the AIR out of SABA?

Kaplan¹,

Mitchell

Cave

et al. 2020

JCM

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For years, standard asthma treatment has included short acting beta agonists (SABA), including as monotherapy in patients with mild asthma symptoms. In the Global Initiative for Asthma 2019 strategy for the management of asthma, the authors recommended a significant departure from the traditional treatments. Short acting beta agonists (SABAs) are no longer recommended as the preferred reliever for patients when they are symptomatic and should not be used at all as monotherapy because of significant safety concerns and poor outcomes. Instead, the more appropriate course is the use of a combined inhaled corticosteroid–fast acting beta agonist as a reliever. This paper discusses the issues associated with the use of SABA, the reasons that patients over-use SABA, difficulties that can be expected in overcoming SABA over-reliance in patients, and our evolving understanding of the use of “anti-inflammatory relievers” in our patients with asthma.

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Section: How Did We Get Here?mentioning

confidence: 99%

Effective Asthma Management: Is It Time to Let the AIR out of SABA?

Kaplan¹,

Mitchell

Cave

et al. 2020

JCM

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“…SAAS is a 12-year, real-life follow-up study of new-onset adult asthma patients giving information on adherence to ICS over an exceptionally long period. In addition, many .999 ƒ Emergency department visits 0 (0-0) 0 (0-0) 0.708 ## Fulfils severe asthma criteria according to ERS/ATS 6 (7.3%) 6 (6.1%) 0.772 ƒ Hospital days, asthma-related § 0 (0-0) 0 (0-0) 0.051 ## Range 0-64 0-12 Hospital days, any respiratory reason § 0 (0-0) 0 (0-0) 0.072 ## Range 0-64 0-37 Asthma control visits 7 (4-11) 6 (3-9) 0.023 ## Asthma-related visits to healthcare 19 (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28) 11 (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19) <0.001 ##…”

Section: Discussionmentioning

confidence: 99%

“…In these studies, the average adherence to ICS was poor, which may be partly explained by the absence of strict diagnostic criteria and confirmed asthma diagnosis, leading to inclusion of nonasthmatic subjects in the study. Conversely, many studies based on health records have used the best information available but shortages in prescription or dispensation data have led to assumptions in adherence calculations [19][20][21][22]. For example, the total day's supply is often based on pharmacists' estimation, typically assuming the maximum use of prescribed doses (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…The 12-year adherence was calculated by using formula 1 and annual adherence was calculated for each patient by using formula 2 (supplementary material). For comparing adherence groups, we used the most common cut-point of 80% [4,21,22…”

Section: Computation Of Adherencementioning

confidence: 99%

“…Many studies based on medical records have used the best information available but the shortages in prescription or dispensation data have led to assumptions in adherence calculations [19][20][21][22]. In addition, previous studies have had shortages of information concerning diagnostic criteria, age of asthma onset and duration of asthma, which may all be factors influencing the results [22][23][24][25]. Though adherence to ICS has been <50% in recent studies, we hypothesised that when patients have a confirmed diagnosis of asthma and regular ICS in use, they would have better medication adherence than previously described.…”

Section: Introductionmentioning

confidence: 99%

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12-year adherence to inhaled corticosteroids in adult-onset asthma

et al. 2020

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Adherence to inhaled corticosteroids (ICS) has been suggested to be poor but long-term follow-ups are lacking. The objective of the present study was to assess adherence to ICS treatment in patients with adult-onset asthma during 12-year follow-up.A total of 181 patients with clinically confirmed, new-onset adult asthma were followed for 12 years as part of the Seinäjoki Adult Asthma Study. Adherence to ICS was assessed individually as the percentage of true dispensed ICS in micrograms per true prescribed daily ICS in micrograms over 12 years.Mean 12-year adherence to ICS was 69% (mean±sd dispensed 2.5±1.8 g and prescribed 3.6±1.5 g budesonide equivalent per patient for 12 years), annual adherence varying between 81% (year 1) and 67% (year 12). Patients with good 12-year adherence (≥80%) used oral corticosteroids more often, and had add-on drugs in use and asthma-related visits to healthcare more often. In addition, they showed less reversibility in forced expiratory volume in 1 s and had higher peripheral blood neutrophil counts. However, lung function decline was steeper in patients with poorer adherence (<80%) and this association remained in multiple linear regression analysis. No difference was found in symptom scores, blood eosinophil counts, exhaled nitric oxide or immunoglobulin E between the patients with different levels of adherence.In patients with adult-onset asthma, adherence to ICS was moderate. Poorer adherence (<80%) to ICS was associated with more rapid decline in lung function but was not associated to symptoms or markers of inflammatory endotypes.

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Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

Scuteri

Vulnera²,

Piro³

et al. 2020

Eur J Clin Pharmacol

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Purpose Data concerning the number of diagnoses and of the drugs prescribed to patients affected by dementia are still scarce. Here we test whether or not (1) prescription of symptomatic drugs against Alzheimer’s disease (AD) may approximate the number of patients affected by dementia in Italy and (2) adherence to this treatment affects the pattern of prescription of drugs (i.e. antipsychotics and antidepressants) for behavioural and psychological symptoms of dementia (BPSD) and the previously reported limited prescription of analgesics. Methods This retrospective observational study concerns 84,235 subjects older than 60 years and registered in the provincial prescription database of the health district of Cosenza accounting for a population of 298,000 inhabitants. The prescribing pattern of antipsychotics, antidepressants, and analgesics has been investigated in patients receiving concurrent prescriptions of acetylcholinesterase inhibitors (AChEI) and/or memantine. Data from a single centre for cognitive disturbances and dementia (CDCD) in the same health district were used to explore at which stage dementia was diagnosed. The study was approved by Calabria Region Ethical Committee no. 31/2017 and registered on October 31, 2017. Results The data show that 859 patients are treated with AChEI and/or memantine; 420 patients (48.89%) receive at least 80% of the recommended medications. CDCD data indicate a delay in dementia diagnosis, which often was made when the patients were moderately to severely demented (Mini Mental State Examination, MMSE ≤ 20). Adherence did not influence prescription of most of the drugs explored, but use of non-steroidal anti-inflammatory drugs was higher in non-adherent patients. Antipsychotics and antidepressants are frequently used (20.61–20.71% and 42.37–51.43%, respectively), and this, at least in part, might stem from the observed under-treatment of chronic pain (opioids are prescribed in the 4.76% and 12.46% of adherent and non-adherent patients and gabapentin and pregabalin are used in the 4.29% and 4.07% of adherent and non-adherent patients respectively), resulting in more frequent BPSD. 16.43% of patients receive antipsychotics for longer than 6–12 weeks. Conclusion This 2-year period study, including a wide cohort of community demented patients, shows that dementia is diagnosed late and that prevalence of BPSD prescriptions is high and not impacted by adherence to anti-dementia drugs. The rate of prescription of potentially harmful antipsychotics and antidepressants appears to be high though whether the concomitantly observed limited prescription of analgesics might be a contributing factor needs to be further investigated. Our data support the development of strategies to improve the management of BPSD.

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

Cited by 48 publications

References 43 publications

Effective Asthma Management: Is It Time to Let the AIR out of SABA?

Effective Asthma Management: Is It Time to Let the AIR out of SABA?

12-year adherence to inhaled corticosteroids in adult-onset asthma

Pattern of treatment of behavioural and psychological symptoms of dementia and pain: evidence on pharmacoutilization from a large real-world sample and from a centre for cognitive disturbances and dementia

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