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

Alberto Papi, Dermot Ryan, Joan B Soriano, Henry Chrystyn, Leif Bjermer, Roberto Rodríguez-Roisin, Myrna B Dolovich, Mark Harris, Lucy Wood, Maria Batsiou, Susannah I Thornhill, David B Price (Corresponding Author)

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BACKGROUND: Patients with asthma and elevated blood eosinophils are at increased risk of severe exacerbations. Management of these patients should consider non-adherence to inhaled corticosteroid (ICS) therapy as a factor for increased exacerbation risk.

OBJECTIVE: 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, at Global Initiative for Asthma (GINA) steps 3 or 4, with ≥2 ICS prescriptions during the year prior to clinical review. Patient characteristics and adherence (based on prescription refills and patient self-report) for ICS therapy were analysed for those with elevated (>400 cells/μL) or normal (≤400 cells/μL) blood eosinophils.

RESULTS: We studied 7,195 patients (66% female, mean age 60 years) with median eosinophil count of 200 cells/μL and found 81% to be non-fully adherent to ICS therapy. 1,031 patients (14%) had elevated blood eosinophil counts (58% female, mean age 60 years), 83% of whom were non-fully adherent to ICS. An increased proportion of adherent patients in the elevated blood eosinophil group had ≥2 exacerbations (14.0% vs 7.2%; p=0.003) and uncontrolled asthma (73% vs 60.8%; p=0.004) as compared to non-fully adherent patients.

CONCLUSIONS: Approximately one in seven 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.

Original languageEnglish
Pages (from-to)1989-1998.e3
Number of pages10
JournalThe journal of allergy and clinical immunology. In practice
Issue number6
Early online date5 Apr 2018
Publication statusPublished - 30 Nov 2018


  • adherence
  • asthma control
  • eosinophils
  • asthma exacerbations
  • inhaled corticosteroids
  • severe asthma


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