Medication use and indicators of poor asthma control in patients with and without allergies
Approximately two-thirds of people with asthma have some evidence of allergy; their condition differs from nonallergic asthma in terms of predominant symptoms and clinical outcomes.
Objective:
To compare asthma control and medication use among patients with persistent asthma with evidence of allergy (PA-EA) and patients with persistent asthma with no evidence of allergy (PA-NEA).
Methods:
A retrospective analysis of survey responses and medication claims data from the Observational Study of Asthma Control and Outcomes study, a prospective survey linked to retrospective claims-based analysis of patients ages ≥ 12 years with persistent asthma in a U.S. health maintenance organization. Evidence of allergy was defined as both a positive response to a survey question about hay fever and/or seasonal allergies and one or more medical diagnostic codes for atopic conditions. Regression models were used to compare asthma control (Asthma Control Questionnaire [ACQ] scores) and asthma medication use between PA-EA and PA-NEA.
Results:
Adjusted data showed that, versus the patients with PA-NEA (n = 312), patients with PA-EA (n = 971) had higher (worse) 5-item and 6-item ACQ (ACQ-5 and ACQ-6) scores (by 0.34 [95% confidence interval {CI}, 0.24‐0.44]; and 0.31 [95% CI, 0.21‐0.40], respectively), were more likely to have poorly controlled asthma (ACQ-5 score ≥ 1.5: odds ratio 3.37 [95% CI, 2.07‐5.50]; ACQ-6 score ≥ 1.5: odds ratio 3.46 [95% CI, 2.13‐5.62]) and less likely to have well-controlled asthma (ACQ-5 score ≤ 0.75: odds ratio 0.21 [95% CI, 0.13‐0.34]; ACQ-6 score ≤ 0.75: odds ratio 0.21 [95% CI, 0.13‐0.35]). Patients with PA-EA also had greater asthma medication use, most notably 2.5 times more prescriptions of high-dose inhaled corticosteroid in a 4-month period (95% CI, 1.21‐5.16) and 16.15 times higher odds of chronic oral corticosteroid use (95% CI, 1.50‐174.09) versus PA-NEA.
Conclusion:
The patients with PA-EA versus PA-NEA had worse asthma control and greater medication use. These patients may need more vigilant clinical oversight and treatment management to ensure adequate asthma control.
Keywords: Asthma; Asthma Control Questionnaire (ACQ); allergic; allergic comorbidity; asthma control; atopic; medication use; non-allergic; persistent; real-world
Document Type: Research Article
Affiliations: 1: From the Department of Pharmacy Practice, Regis University School of Pharmacy, Denver, Colorado 2: Allergy, Asthma & Immunology, AAADRS Clinical Research Center, Coral Gables, Florida 3: Center for Pharmaceutical Outcomes Research, Department of Clinical Pharmacy, University of Colorado, Aurora, Colorado 4: Novartis Pharmaceuticals Corporation, East Hanover, New Jersey 5: Department of Medicine, Division of Pulmonary Diseases and Critical Care, UT Health, San Antonio, Texas
Publication date: 01 July 2019
This article was made available online on 03 May 2019 as a Fast Track article with title: "Medication use and indicators of poor asthma control in patients with and without allergies ".
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