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Medication use and indicators of poor asthma control in patients with and without allergies

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Background:

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.
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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: July 1, 2019

This article was made available online on May 3, 2019 as a Fast Track article with title: "Medication use and indicators of poor asthma control in patients with and without allergies ".

More about this publication?
  • Allergy and Asthma Proceedings is a peer reviewed publication dedicated to distributing timely scientific research regarding advancements in the knowledge and practice of allergy, asthma and immunology. Its primary readership consists of allergists and pulmonologists.

    The goal of the Proceedings is to publish articles with a predominantly clinical focus which directly impact quality of care for patients with allergic disease and asthma and by having the potential to directly impact the quality of patient care. AAP welcomes the submission of original works including peer-reviewed original research and clinical trial results. Additionally, as the official journal of the Eastern Allergy Conference (EAC), AAP will publish content from EAC poster sessions as well as review articles derived from EAC lectures.

    Featured topics include asthma, rhinitis, sinusitis, food allergies, allergic skin diseases, diagnostic techniques, allergens, and treatment modalities. Published material includes peer-reviewed original research, clinical trials and review articles.

    Articles marked "F" offer free full text for personal noncommercial use only.

    The journal is indexed in Thomson Reuters Web of Science and Science Citation Index Expanded, plus the National Library of Medicine's PubMed service.
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