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

doi:10.1016/j.jaip.2018.03.008

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)

^*Corresponding author for this work

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Abstract

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 language	English
Pages (from-to)	1989-1998.e3
Number of pages	10
Journal	The journal of allergy and clinical immunology. In practice
Volume	6
Issue number	6
Early online date	5 Apr 2018
DOIs	https://doi.org/10.1016/j.jaip.2018.03.008
Publication status	Published - 30 Nov 2018

Bibliographical note

This study was funded by Teva Pharmaceuticals.

Keywords

adherence
asthma control
eosinophils
asthma exacerbations
inhaled corticosteroids
severe asthma

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Cite this

Papi, A., Ryan, D., Soriano, J. B., Chrystyn, H., Bjermer, L., Rodríguez-Roisin, R., Dolovich, M. B., Harris, M., Wood, L., Batsiou, M., Thornhill, S. I., & Price, D. B. (2018). Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma. The journal of allergy and clinical immunology. In practice, 6(6), 1989-1998.e3. https://doi.org/10.1016/j.jaip.2018.03.008

Papi, A, Ryan, D, Soriano, JB, Chrystyn, H, Bjermer, L, Rodríguez-Roisin, R, Dolovich, MB, Harris, M, Wood, L, Batsiou, M, Thornhill, SI & Price, DB 2018, 'Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma', The journal of allergy and clinical immunology. In practice, vol. 6, no. 6, pp. 1989-1998.e3. https://doi.org/10.1016/j.jaip.2018.03.008

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title = "Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma",

abstract = "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.",

keywords = "adherence, asthma control, eosinophils, asthma exacerbations, inhaled corticosteroids, severe asthma",

author = "Alberto Papi and Dermot Ryan and Soriano, {Joan B} and Henry Chrystyn and Leif Bjermer and Roberto Rodr{\'i}guez-Roisin and Dolovich, {Myrna B} and Mark Harris and Lucy Wood and Maria Batsiou and Thornhill, {Susannah I} and Price, {David B}",

note = "This study was funded by Teva Pharmaceuticals.",

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doi = "10.1016/j.jaip.2018.03.008",

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T1 - Relationship of Inhaled Corticosteroid Adherence to Asthma Exacerbations in Patients with Moderate-to-Severe Asthma

AU - Papi, Alberto

AU - Ryan, Dermot

AU - Soriano, Joan B

AU - Chrystyn, Henry

AU - Bjermer, Leif

AU - Rodríguez-Roisin, Roberto

AU - Dolovich, Myrna B

AU - Harris, Mark

AU - Wood, Lucy

AU - Batsiou, Maria

AU - Thornhill, Susannah I

AU - Price, David B

N1 - This study was funded by Teva Pharmaceuticals.

PY - 2018/11/30

Y1 - 2018/11/30

N2 - 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.

AB - 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.

KW - adherence

KW - asthma control

KW - eosinophils

KW - asthma exacerbations

KW - inhaled corticosteroids

KW - severe asthma

U2 - 10.1016/j.jaip.2018.03.008

DO - 10.1016/j.jaip.2018.03.008

M3 - Article

C2 - 29627457

SN - 2213-2198

VL - 6

SP - 1989-1998.e3

JO - The journal of allergy and clinical immunology. In practice

JF - The journal of allergy and clinical immunology. In practice

IS - 6

ER -

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

Abstract

Bibliographical note

Keywords

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