Quantifying the proportion of severe asthma exacerbations attributable to inhaled corticosteroid nonadherence - 30/11/11
, Edward L. Peterson, PhD c, Karen Wells, BS c, Brian K. Ahmedani, PhD a, Rajesh Kumar, MD, MS d, Esteban G. Burchard, MD, MPH e, f, Vimal K. Chowdhry, PhD a, David Favro, BS a, David E. Lanfear, MD, MS a, b, Manel Pladevall, MD, MS a, g
Corresponding author: L. Keoki Williams, MD, MPH, Center for Health Services Research, Henry Ford Hospital, 1 Ford Place, 3A CHSR, Detroit, MI 48202.Abstract |
Background |
Asthma is an inflammatory condition often punctuated by episodic symptomatic worsening, and accordingly, patients with asthma might have waxing and waning adherence to controller therapy.
Objective |
We sought to measure changes in inhaled corticosteroid (ICS) adherence over time and to estimate the effect of this changing pattern of use on asthma exacerbations.
Methods |
ICS adherence was estimated from electronic prescription and fill information for 298 participants in the Study of Asthma Phenotypes and Pharmacogenomic Interactions by Race-Ethnicity. For each patient, we calculated a moving average of ICS adherence for each day of follow-up. Asthma exacerbations were defined as the need for oral corticosteroids, an asthma-related emergency department visit, or an asthma-related hospitalization. Proportional hazard models were used to assess the relationship between ICS medication adherence and asthma exacerbations.
Results |
Adherence to ICS medications began to increase before the first asthma exacerbation and continued afterward. Adherence was associated with a reduction in exacerbations but was only statistically significant among patients whose adherence was greater than 75% of the prescribed dose (hazard ratio, 0.61; 95% CI, 0.41-0.90) when compared with patients whose adherence was 25% or less. This pattern was largely confined to patients whose asthma was not well controlled initially. An estimated 24% of asthma exacerbations were attributable to ICS medication nonadherence.
Conclusions |
ICS adherence varies in the time period leading up to and after an asthma exacerbation, and nonadherence likely contributes to a large number of these exacerbations. High levels of adherence are likely required to prevent these events.
Le texte complet de cet article est disponible en PDF.Key words : Medication adherence, inhaled corticosteroids, asthma, patient compliance, asthma exacerbations
Abbreviations used : ACT, ED, HR, ICS, SABA, SAPPHIRE
Plan
| Supported by grants from the Fund for Henry Ford Hospital, the American Asthma Foundation, and the National Institute of Allergy and Infectious Diseases (R01AI079139 and R01AI061774); the National Heart, Lung, and Blood Institute (NHLBI; R01HL079055), and the National Institute of Diabetes and Digestive and Kidney Diseases (R01DK064695), National Institutes of Health (NIH; to L.K.W.). E.G.B. receives funding through the NHLBI/NIH (R01HL078885 and R01HL088133) and the Flight Attendant Medical Research Institute. R.K. also receives funding through the NHLBI/NIH (K23HL093023-01). These funding agencies did not have a role in the study design, analysis, drafting of the manuscript, or revision of the manuscript. |
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| Disclosure of potential conflict of interest: L. K. Williams has received research support from the National Institute of Allergy and Infectious Diseases, the National Heart Lung and Blood Institute (NHLBI), and the National Institute of Diabetes and Digestive and Kidney Diseases (National Institutes of Health), as well as the American Asthma Foundation. R. Kumar has received research support from the NHLBI. The rest of the authors declare that they have no relevant conflicts of interest. |
Vol 128 - N° 6
P. 1185 - décembre 2011 Retour au numéro
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