Patterns of oral corticosteroids use in primary care patients with severe asthma

Davide L Vetrano; Alberto Zucchelli; Elisa Bianchini; Ettore Marconi; Francesco P Lombardo; Claudio Cricelli; Francesco Lapi

doi:10.1016/j.rmed.2020.105946

Patterns of oral corticosteroids use in primary care patients with severe asthma

Respir Med. 2020 May:166:105946. doi: 10.1016/j.rmed.2020.105946. Epub 2020 Mar 25.

Authors

Davide L Vetrano¹, Alberto Zucchelli², Elisa Bianchini³, Ettore Marconi³, Francesco P Lombardo⁴, Claudio Cricelli⁴, Francesco Lapi⁵

Affiliations

¹ Dept. of Geriatrics, Catholic University of Rome and IRCCS Fondazione Policlinico "A. Gemelli", Rome, Italy; Aging Research Center, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet and Stockholm University, Sweden.
² Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
³ Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy.
⁴ Italian College of General Practitioners and Primary Care, Florence, Italy.
⁵ Health Search, Italian College of General Practitioners and Primary Care, Florence, Italy. Electronic address: lapi.francesco@simg.it.

PMID: 32250874
DOI: 10.1016/j.rmed.2020.105946

Abstract

Aim: To assess the pattern of use of oral corticosteroids (OC) in primary care patients with severe asthma.

Methods: Data derived from the Health Search Database (HSD) gathering information on 700 Italian general practitioners. A cohort of severe asthma patients was identified between 2013 and 2017 and followed-up for one year. The association between candidate predictors and the incident escalation to OC was tested through a multivariate Cox regression model.

Results: Among patients with asthma (N = 55,075), 284 were diagnosed with severe asthma. Among them, the proportion of OC users decreased from 82.2% in 2013 to 75.3% in 2017. For what concerns the determinants of OC prescriptions, among 284 patients being defined at baseline (2013-2016) as those suffering from severe asthma, 216 (76.1%) were first-ever prescribed with OC at least once during one year of follow-up. The presence of gastroesophageal reflux disease (HR 1.37; 95% CI 1.02-1.85), osteoarthritis (HR 1.54; 95% CI 1.12-2.12) and moderate asthma exacerbations (HR 1.72; 95% CI 1-02-2.93) was significantly associated with the outcome.

Conclusions: The optimization of asthma treatment and the management of comorbidities may be potential leverages to reduce the inappropriate use of OC in patients with severe asthma.

Keywords: Asthma; Clinical guidelines; Corticosteroids; Primary care.

Publication types

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

MeSH terms

Administration, Oral
Adrenal Cortex Hormones / administration & dosage*
Asthma / drug therapy*
Asthma / epidemiology
Cohort Studies
Comorbidity
Data Interpretation, Statistical
Databases, Factual*
Disease Progression
Female
Follow-Up Studies
Gastroesophageal Reflux / epidemiology
Humans
Male
Osteoarthritis / epidemiology
Primary Health Care*
Severity of Illness Index
Treatment Outcome

Substances

Adrenal Cortex Hormones