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 journalArticle

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 languageEnglish (US)
JournalJournal of Allergy and Clinical Immunology: In Practice
DOIs
StateAccepted/In press - Jan 1 2019

Fingerprint

Adrenal Cortex Hormones
Asthma
Prescriptions
Outpatients
Anti-Bacterial Agents
Leukotriene Antagonists
Multilevel Analysis
Chronic Obstructive Pulmonary Disease
Comorbidity
Primary Health Care
Patient Care
Hospitalization
Emergencies
Maintenance
Databases
Physicians
Research

Keywords

  • Adherence
  • Inhaled corticosteroids (ICSs)
  • Longitudinal study
  • Multilevel modeling
  • OPCRD
  • Risk domain asthma control

ASJC Scopus subject areas

  • Immunology and Allergy

Cite this

The Relationship Between Real-World Inhaled Corticosteroid Adherence and Asthma Outcomes : A Multilevel Approach. / Respiratory Effectiveness Group's Adherence Working Group.

In: Journal of Allergy and Clinical Immunology: In Practice, 01.01.2019.

Research output: Contribution to journalArticle

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author = "{Respiratory Effectiveness Group's Adherence Working Group} and 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 Michelle Eakin and Tjard Schermer and Souverein, {Patrick C.} and Dima, {Alexandra L.}",
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T2 - A Multilevel Approach

AU - Respiratory Effectiveness Group's Adherence Working Group

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

AU - Schermer, Tjard

AU - Souverein, Patrick C.

AU - Dima, Alexandra L.

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KW - Inhaled corticosteroids (ICSs)

KW - Longitudinal study

KW - Multilevel modeling

KW - OPCRD

KW - Risk domain asthma control

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