The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach

Respiratory Effectiveness Group's Adherence Working Group

doi:10.1016/j.jaip.2019.09.003

The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach

Respiratory Effectiveness Group's Adherence Working Group

Research output: Contribution to journal › Article › peer-review

19 Citations (Scopus)

Abstract

BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences.

OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence.

METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics.

RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation.

CONCLUSIONS: Patients may adapt their ICS use to their current needs without this impacting later RDAC.

Original language	English
Pages (from-to)	626-634
Number of pages	9
Journal	The Journal of Allergy and Clinical Immunology: In Practice
Volume	8
Issue number	2
Early online date	18 Sept 2019
DOIs	https://doi.org/10.1016/j.jaip.2019.09.003
Publication status	Published - Feb 2020

Bibliographical note

This study was funded by the Respiratory Effectiveness Group, an international, investigator-led, not-for-profit, real-life respiratory research and advocacy initiative (http://www.effectivenessevaluation.org). The data set was provided by Optimum Patient Care Ltd as a donation in kind.

Keywords

Risk domain asthma control
Inhaled corticosteroids (ICSs)
Adherence
Longitudinal study
Multilevel modeling
OPCRD
MEDICATION
IMPACT
EXACERBATIONS
INAPPROPRIATE USE
ACTING BETA-AGONISTS

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Cite this

@article{aab0783789b44aefbcf3d797115a05b3,

title = "The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach",

abstract = "BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences.OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence.METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics.RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation.CONCLUSIONS: Patients may adapt their ICS use to their current needs without this impacting later RDAC.",

keywords = "Risk domain asthma control, Inhaled corticosteroids (ICSs), Adherence, Longitudinal study, Multilevel modeling, OPCRD, MEDICATION, IMPACT, EXACERBATIONS, INAPPROPRIATE USE, ACTING BETA-AGONISTS",

author = "Marcia Vervloet and {van Dijk}, Liset and Peter Spreeuwenberg and David Price and Alison Chisholm and {Van Ganse}, Eric and Hilary Pinnock and Rand, {Cynthia S} and Eakin, {Michelle N} and Tjard Schermer and Souverein, {Patrick C} and Dima, {Alexandra L} and {Respiratory Effectiveness Group's Adherence Working Group}",

note = "This study was funded by the Respiratory Effectiveness Group, an international, investigator-led, not-for-profit, real-life respiratory research and advocacy initiative (http://www.effectivenessevaluation.org). The data set was provided by Optimum Patient Care Ltd as a donation in kind. ",

year = "2020",

month = feb,

doi = "10.1016/j.jaip.2019.09.003",

language = "English",

volume = "8",

pages = "626--634",

journal = "The Journal of Allergy and Clinical Immunology: In Practice",

issn = "2213-2198",

publisher = "Elsevier",

number = "2",

}

TY - JOUR

T1 - The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes

T2 - A Multilevel Approach

AU - Vervloet, Marcia

AU - van Dijk, Liset

AU - Spreeuwenberg, Peter

AU - Price, David

AU - Chisholm, Alison

AU - Van Ganse, Eric

AU - Pinnock, Hilary

AU - Rand, Cynthia S

AU - Eakin, Michelle N

AU - Schermer, Tjard

AU - Souverein, Patrick C

AU - Dima, Alexandra L

AU - Respiratory Effectiveness Group's Adherence Working Group

N1 - This study was funded by the Respiratory Effectiveness Group, an international, investigator-led, not-for-profit, real-life respiratory research and advocacy initiative (http://www.effectivenessevaluation.org). The data set was provided by Optimum Patient Care Ltd as a donation in kind.

PY - 2020/2

Y1 - 2020/2

N2 - BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences.OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence.METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics.RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation.CONCLUSIONS: Patients may adapt their ICS use to their current needs without this impacting later RDAC.

AB - BACKGROUND: Low inhaled corticosteroid (ICS) adherence is associated with increased asthma burden. This relationship is likely bidirectional, and may vary across adherence stages (initiation, implementation, and persistence). Studies rarely examine reciprocal influences.OBJECTIVE: To investigate the relationship between ICS implementation and asthma-related outcomes over 2 years, considering bidirectionality and temporal sequence.METHODS: Primary care records (1987-2012) from the Optimum Patient Care Research Database, United Kingdom, were used. Eligible patients were 6 years or older and had 3 or more years of continuous registration starting 1 year before ICS initiation (index date), physician-diagnosed asthma, 2 or more ICS and/or short-acting β-agonist prescriptions each follow-up year, and no long-acting β-agonists, leukotriene receptor antagonists, or maintenance oral corticosteroids in the preceding year. ICS implementation (percentage of days covered) and risk domain asthma control (RDAC; no asthma-related hospitalizations, emergency visits, or outpatient visits and no oral corticosteroid or antibiotic prescriptions with evidence of respiratory review) were estimated for each prescription interval (period between 2 successive prescriptions). Multilevel analyses modeled bidirectional relationships between ICS implementation and RDAC (and its components), controlling for sociodemographic and clinical characteristics.RESULTS: In prescription data from 10,472 patients, ICS implementation in the preceding interval did not predict RDAC, but was weakly positively associated with simultaneous RDAC. Being male, non-current smoker, without chronic obstructive pulmonary disease diagnosis, and with fewer than 4 comorbidities significantly increased odds of RDAC. Asthma-related antibiotics and outpatient visits in the same interval and short-acting β-agonist overuse in the preceding and same interval predicted lower ICS implementation.CONCLUSIONS: Patients may adapt their ICS use to their current needs without this impacting later RDAC.

KW - Risk domain asthma control

KW - Inhaled corticosteroids (ICSs)

KW - Adherence

KW - Longitudinal study

KW - Multilevel modeling

KW - OPCRD

KW - MEDICATION

KW - IMPACT

KW - EXACERBATIONS

KW - INAPPROPRIATE USE

KW - ACTING BETA-AGONISTS

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U2 - 10.1016/j.jaip.2019.09.003

DO - 10.1016/j.jaip.2019.09.003

M3 - Article

C2 - 31541763

SN - 2213-2198

VL - 8

SP - 626

EP - 634

JO - The Journal of Allergy and Clinical Immunology: In Practice

JF - The Journal of Allergy and Clinical Immunology: In Practice

IS - 2

ER -

The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes: A Multilevel Approach

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Keywords

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