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Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy.
J Allergy Clin Immunol Pract. 2014 Sep-Oct; 2(5):570-4.e1.JA

Abstract

BACKGROUND

Few data exist regarding the natural history of asthma exacerbations over time.

OBJECTIVE

To evaluate the frequency and risk factors of asthma exacerbation occurrence over a 5-year period in a large cohort of adult patients with persistent asthma.

METHODS

Health insurance claims from the Truven Health MarketScan database were analyzed for 2543 patients who had full medical and drug claims for years 2006 to 2011, did not have co-occurring chronic obstructive pulmonary disease in the index year (2006), and were treated with high-dose inhaled corticosteroids and long-acting β2-agonists for at least 120 days ("high intensity" therapy) in the index year. A retrospective analysis was conducted to assess the pattern of severe exacerbations (encounter with health care system and steroid burst) over time and their associations with the other measures of health status.

RESULTS

Despite the use of high-intensity asthma therapy, there was only a small decrease in total asthma exacerbations over time, but no significant time trend for asthma hospitalizations. An exacerbation in the prior year increased the risk for exacerbations almost 8-fold, (odds ratio 7.8 [95% CI, 7.1-8.6]). A 50% increase in exacerbation risk (odds ratio 1.5 [95% CI, 1.4-1.6]) was associated with continued high-intensity treatment for the duration of the study. Patients with encounters of chronic obstructive pulmonary disease after the index year were at 60% increased risk of an exacerbation.

CONCLUSIONS

This study showed that exacerbation rates for patients with asthma in a real-world setting remained relatively constant over time, and continuous high treatment intensity was not associated with a substantially lower risk of exacerbations.

Authors+Show Affiliations

Department of Allergy, Kaiser-Permanente, Medical Center, San Diego, Calif. Electronic address: Michael.x.schatz@kp.org.Health Economics and Reimbursement, Boston Scientific, Natick, Mass; Trinity Partners, Waltham, Mass.Health Economics and Reimbursement, Boston Scientific, Natick, Mass.Health Economics and Reimbursement, Boston Scientific, Natick, Mass.Alan A. and Edith L. Wolff Chair in Pulmonary and Critical Care Medicine, Washington University School of Medicine, St Louis, Mo.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25213050

Citation

Schatz, Michael, et al. "Asthma Exacerbation Rates in Adults Are Unchanged Over a 5-year Period Despite High-intensity Therapy." The Journal of Allergy and Clinical Immunology. in Practice, vol. 2, no. 5, 2014, pp. 570-4.e1.
Schatz M, Meckley LM, Kim M, et al. Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy. J Allergy Clin Immunol Pract. 2014;2(5):570-4.e1.
Schatz, M., Meckley, L. M., Kim, M., Stockwell, B. T., & Castro, M. (2014). Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy. The Journal of Allergy and Clinical Immunology. in Practice, 2(5), 570-e1. https://doi.org/10.1016/j.jaip.2014.05.002
Schatz M, et al. Asthma Exacerbation Rates in Adults Are Unchanged Over a 5-year Period Despite High-intensity Therapy. J Allergy Clin Immunol Pract. 2014 Sep-Oct;2(5):570-4.e1. PubMed PMID: 25213050.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Asthma exacerbation rates in adults are unchanged over a 5-year period despite high-intensity therapy. AU - Schatz,Michael, AU - Meckley,Lisa M, AU - Kim,Micheline, AU - Stockwell,Benjamin T, AU - Castro,Mario, Y1 - 2014/07/03/ PY - 2014/03/04/received PY - 2014/04/11/revised PY - 2014/05/08/accepted PY - 2014/9/13/entrez PY - 2014/9/13/pubmed PY - 2015/5/20/medline KW - Asthma KW - Exacerbations KW - Inhaled corticosteroids KW - Long-acting β-agonists KW - Natural history SP - 570 EP - 4.e1 JF - The journal of allergy and clinical immunology. In practice JO - J Allergy Clin Immunol Pract VL - 2 IS - 5 N2 - BACKGROUND: Few data exist regarding the natural history of asthma exacerbations over time. OBJECTIVE: To evaluate the frequency and risk factors of asthma exacerbation occurrence over a 5-year period in a large cohort of adult patients with persistent asthma. METHODS: Health insurance claims from the Truven Health MarketScan database were analyzed for 2543 patients who had full medical and drug claims for years 2006 to 2011, did not have co-occurring chronic obstructive pulmonary disease in the index year (2006), and were treated with high-dose inhaled corticosteroids and long-acting β2-agonists for at least 120 days ("high intensity" therapy) in the index year. A retrospective analysis was conducted to assess the pattern of severe exacerbations (encounter with health care system and steroid burst) over time and their associations with the other measures of health status. RESULTS: Despite the use of high-intensity asthma therapy, there was only a small decrease in total asthma exacerbations over time, but no significant time trend for asthma hospitalizations. An exacerbation in the prior year increased the risk for exacerbations almost 8-fold, (odds ratio 7.8 [95% CI, 7.1-8.6]). A 50% increase in exacerbation risk (odds ratio 1.5 [95% CI, 1.4-1.6]) was associated with continued high-intensity treatment for the duration of the study. Patients with encounters of chronic obstructive pulmonary disease after the index year were at 60% increased risk of an exacerbation. CONCLUSIONS: This study showed that exacerbation rates for patients with asthma in a real-world setting remained relatively constant over time, and continuous high treatment intensity was not associated with a substantially lower risk of exacerbations. SN - 2213-2201 UR - https://www.unboundmedicine.com/medline/citation/25213050/Asthma_exacerbation_rates_in_adults_are_unchanged_over_a_5_year_period_despite_high_intensity_therapy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S2213-2198(14)00188-3 DB - PRIME DP - Unbound Medicine ER -