Dataset Information

Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom.

ABSTRACT:

Background

Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes.

Objective

We sought to describe the evolution and trajectory of intermittent OCS prescription patterns in patients with asthma and investigate risk factors independently associated with transitioning to a frequent prescription pattern.

Methods

This historical cohort study included patients with active asthma managed in UK primary care and included in the Optimum Patient Care Research Database (OPCRD; opcrd.co.uk). Intermittent OCS prescription patterns were categorized as sporadic, infrequent, moderately frequent, or frequent. Prescription pattern sequences were described for those who had a frequent sequence in their final year of prescribing. We examined associations between OCS prescription pattern and the hazard of transitioning into a frequent intermittent OCS prescription pattern using multivariable Cox regression with a 10-year look-back period.

Results

Of 105,229 patients with intermittent OCS prescriptions, 57.1% (n = 60,083) had a frequent OCS prescription pattern at some point. Irrespective of baseline pattern, most patients transitioned to frequent prescription during the look back. The strongest risk factors were a more frequent prescription pattern at the start of look-back period, a lower percentage peak expiratory flow rate, and higher Global Initiative for Asthma treatment step. Older age, female sex, obesity, and active smoking were also associated with a higher risk of transitioning.

Conclusion

Our findings help identify those most at risk of transitioning to frequent intermittent OCS receipt and encourage earlier intervention with OCS-sparing treatments.

SUBMITTER: Tran TN

PROVIDER: S-EPMC10959664 | biostudies-literature | 2024 May

REPOSITORIES: biostudies-literature

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Publications

Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom.

Tran Trung N TN Heatley Heath H Rowell Jennifer J Chan Jeffrey Shi Kai JSK Bourdin Arnaud A Chapaneri Jatin J Emmanuel Benjamin B Gibson Danny D Jackson David J DJ Menzies-Gow Andrew N AN Murray Ruth R Skinner Derek D Price David B DB

The journal of allergy and clinical immunology. Global 20240202 2

<h4>Background</h4>Increasing frequency of intermittent oral corticosteroid (OCS) prescription and cumulative OCS exposure increase the risk of OCS-related adverse outcomes.<h4>Objective</h4>We sought to describe the evolution and trajectory of intermittent OCS prescription patterns in patients with asthma and investigate risk factors independently associated with transitioning to a frequent prescription pattern.<h4>Methods</h4>This historical cohort study included patients with active asthma ma ...[more]

PMID: 38524787

Similar Datasets

Project description:ObjectiveTo estimate the level of dispensing of oral corticosteroids (OCS) for managing asthma in Australia, with a particular focus on the cumulative dispensing of doses associated with long term toxicity (≥ 1000 mg prednisolone-equivalent).DesignRetrospective cohort study; analysis of 10% random sample of Pharmaceutical Benefits Scheme (PBS) dispensing data.Participants, settingPeople aged 12 years or more treated for asthma during 2014-2018, according to dispensing of controller inhaled corticosteroids (ICS).Main outcome measuresNumber of people dispensed OCS for managing asthma during 2014-2018; proportion who were cumulatively dispensed at least 1000 mg prednisolone-equivalent. The secondary outcome was the number of people dispensed at least 1000 mg prednisolone-equivalent during 2018, stratified by inhaler controller dose and use.Results124 011 people had been dispensed at least two prescriptions of ICS during 2014-2018 and met the study definition for asthma, of whom 64 112 (51.7%) had also been dispensed OCS, including 34 580 (27.9% of the asthma group) cumulatively dispensed 1000 mg prednisolone-equivalent or more. Of 138 073 people dispensed OCS at this level, 68 077 (49%) were patients with airway diseases. Dispensing of diabetes and osteoporosis medications was more common for people cumulatively dispensed 1000 mg prednisolone-equivalent or more. During 2018, 4633 people with asthma using high dose ICS controllers were dispensed 1000 mg prednisolone-equivalent or more, for 2316 of whom (50%) controller use was inadequate.ConclusionsCumulative exposure to OCS in Australia reaches levels associated with toxicity in one-quarter of patients with asthma using ICS. Cumulative dispensing of potentially toxic OCS amounts often accompanies inadequate inhaler controller dispensing. Better approaches are needed to improve adherence to controller therapy, improve outcomes for people with asthma, and to minimise the use and toxicity of OCS.

Dataset Information

Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom.

Background

Objective

Methods

Results

Conclusion

Publications

Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom.

Similar Datasets

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