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McCrossan P, Shields MD, McElnay JC. Medication Adherence in Children with Asthma. Patient Prefer Adherence 2024; 18:555-564. [PMID: 38476591 PMCID: PMC10929205 DOI: 10.2147/ppa.s445534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Accepted: 02/06/2024] [Indexed: 03/14/2024] Open
Abstract
Asthma is the most common chronic disease in childhood. If untreated, asthma can lead to debilitating daily symptoms which affect quality of life, but more importantly can lead to fatal asthma attacks which unfortunately still occur globally. The most effective treatment strategy for controlling asthma is for the patient to follow a personalised asthma action plan (PAAP) which will invariably include regular use of an inhaled corticosteroid. To examine medication adherence in children with asthma, we collated recent evidence from systematic reviews in this area to address the following 5 key questions; What is adherence? Is there evidence that children are not adhering to preventer medication? Why is adherence poor and what are the barriers to adherence? Does good adherence improve outcomes in asthma? And lastly, how can treatment adherence be improved?
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Affiliation(s)
- Paddy McCrossan
- Paediatric Respiratory Medicine, Royal Belfast Hospital for Sick Children, Belfast, Northern Ireland
| | - Michael D Shields
- Wellcome-Wolfson Institute for Experimental Medicine, Queen’s University Belfast, Belfast, Northern Ireland
| | - James C McElnay
- School of Pharmacy, Queen’s University Belfast, Belfast, Northern Ireland
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2
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Mommers I, van Boven JFM, Schuiling-Veninga CCM, Bos JHJ, Koetsier M, Hak E, Bijlsma MJ. Real-World Dispensing Patterns of Inhalation Medication in Young Adult Asthma: An Inception Cohort Study. Clin Epidemiol 2023; 15:721-732. [PMID: 37337562 PMCID: PMC10276997 DOI: 10.2147/clep.s410036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 05/08/2023] [Indexed: 06/21/2023] Open
Abstract
Purpose The Global Initiative for Asthma (GINA) suggests a step-wise approach for pharmacological treatment of asthma. Valid study of real-world treatment patterns using dispensing databases includes proper measurement of medication adherence. We aim to explore such patterns by applying a time-varying proportion of days covered (tPDC)-based algorithm. Patients and Methods We designed a retrospective inception cohort study using the University of Groningen IADB.nl community pharmacy dispensing database. Included were 19,184 young adults who initiated asthma medication anywhere between 1994 and 2021, in the Netherlands. Main treatment steps were defined as: 1 - SABA/ICS-formoterol as needed, 2 - low dose ICS, 3 - low dose ICS + LABA or tiotropium, or intermediate dose ICS, 4 - intermediate to high dose ICS + LABA or tiotropium, triple therapy, or high dose ICS, 5 - treatment prescribed by a specialist. Changes in treatment steps were determined using a time-varying proportion of days covered (tPDC)-based algorithm. Individual drug treatment trajectories were visualized over time using a lasagna plot. Results At initiation, of the 19,184 included individuals, 52%, 7%, 15%, 16%, and 10% started treatment in steps 1 to 5, respectively. The median (IQR) follow-up time was 3 (1-7) years. Median (IQR) number of switches was 1 (0-3). Comparing starting step to last observed step, 37% never switched between treatment steps, 20% of individuals stepped down and 22% stepped up. Conclusion The low proportion of treatment switches between steps indicates that tailoring of treatment to patients' needs might be suboptimal. The tPDC-based algorithm functions well in translating dispensing data into continuous drug-utilization data, enabling a more granular assessment of treatment patterns among asthma patients.
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Affiliation(s)
- Irene Mommers
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Job F M van Boven
- Groningen Research Institute for Asthma and COPD, University Medical Center Groningen, Groningen, the Netherlands
- Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Jens H J Bos
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Marten Koetsier
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Eelko Hak
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
| | - Maarten J Bijlsma
- Pharmacotherapy, Epidemiology and -Economics, University of Groningen, Groningen, the Netherlands
- Laboratory of Population Health, Max Planck Institute for Demographic Research, Rostock, Germany
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3
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Tibble H, Sheikh A, Tsanas A. Derivation of asthma severity from electronic prescription records using British thoracic society treatment steps. BMC Pulm Med 2022; 22:397. [PMCID: PMC9635147 DOI: 10.1186/s12890-022-02189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 09/27/2022] [Accepted: 09/29/2022] [Indexed: 11/06/2022] Open
Abstract
Abstract
Background:
Asthma severity is typically assessed through a retrospective assessment of the treatment required to control symptoms and to prevent exacerbations. The joint British Thoracic Society and Scottish Intercollegiate Guidelines Network (BTS/SIGN) guidelines encourage a stepwise approach to pharmacotherapy, and as such, current treatment step can be considered as a severity categorisation proxy. Briefly, the steps for adults can be summarised as: no controller therapy (Step 0), low-strength Inhaled Corticosteroids (ICS; Step 1), ICS plus Long-Acting Beta-2 Agonist (LABA; Step 2), medium-dose ICS + LABA (Step 3), and finally either an increase in strength or additional therapies (Step 4). This study aimed to investigate how BTS/SIGN Steps can be estimated from across a large cohort using electronic prescription records, and to describe the incidence of each BTS/SIGN Step in a general population.
Methods:
There were 41,433,707 prescriptions, for 671,304 individuals, in the Asthma Learning Health System Scottish cohort, between 1/2009 and 3/2017. Days on which an individual had a prescription for at least one asthma controller (preventer) medication were labelled prescription events. A rule-based algorithm was developed for extracting the strength and volume of medication instructed to be taken daily from free-text data fields. Asthma treatment regimens were categorised by the combination of medications prescribed in the 120 days preceding any prescription event and categorised into BTS/SIGN treatment steps.
Results:
Almost 4.5 million ALHS prescriptions were for asthma controllers. 26% of prescription events had no inhaled corticosteroid prescriptions in the preceding 120 days (Step 0), 16% were assigned to BTS/SIGN Step 1, 7% to Step 2, 21% to Step 3, and 30% to Step 4. The median days spent on a treatment step before a step-down in treatment was 297 days, whereas a step-up only took a median of 134 days.
Conclusion
We developed a reproducible methodology enabling researchers to estimate BTS/SIGN asthma treatment steps in population health studies, providing valuable insights into population and patient-specific trajectories, towards improving the management of asthma.
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Hatter L, Bruce P, Holliday M, Anderson AJ, Braithwaite I, Corin A, Eathorne A, Grimes A, Harwood M, Hills T, Kearns C, Kerse K, Martindale J, Montgomery B, Riggs L, Sheahan D, Shortt N, Zazulia K, Weatherall M, McNamara D, Byrnes CA, Bush A, Dalziel SR, Beasley R. The Children's Anti-inflammatory Reliever (CARE) study: a protocol for a randomised controlled trial of budesonide-formoterol as sole reliever therapy in children with mild asthma. ERJ Open Res 2021; 7:00271-2021. [PMID: 34853785 PMCID: PMC8628747 DOI: 10.1183/23120541.00271-2021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 06/08/2021] [Indexed: 11/17/2022] Open
Abstract
Background Asthma is the most common chronic disease in children, many of whom are managed solely with a short-acting β2-agonist (SABA). In adults, the evidence that budesonide-formoterol as sole reliever therapy markedly reduces the risk of severe exacerbations compared with SABA alone has contributed to the Global Initiative for Asthma recommending against SABA monotherapy in this population. The current lack of evidence in children means it is unknown whether these findings are also relevant to this demographic. High-quality randomised controlled trials (RCTs) are needed. Objective The aim of this study is to determine the efficacy and safety of as-needed budesonide-formoterol therapy compared with as-needed salbutamol in children aged 5 to 15 years with mild asthma, who only use a SABA. Methods A 52-week, open-label, parallel group, phase III RCT will recruit 380 children aged 5 to 15 years with mild asthma. Participants will be randomised 1:1 to either budesonide-formoterol (Symbicort Rapihaler®) 50/3 µg, two actuations as needed, or salbutamol (Ventolin®) 100 µg, two actuations as needed. The primary outcome is asthma attacks as rate per participant per year. Secondary outcomes assess asthma control, lung function, exhaled nitric oxide and treatment step change. A cost-effectiveness analysis is also planned. Conclusion This is the first RCT to assess the safety and efficacy of as-needed budesonide-formoterol in children with mild asthma. The results will provide a much-needed evidence base for the treatment of mild asthma in children. This protocol describes the first randomised controlled trial to investigate the efficacy and safety of budesonide/formoterol as sole reliever therapy for children with mild asthma, providing urgently needed evidence in this populationhttps://bit.ly/35v0R3Z
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Affiliation(s)
- Lee Hatter
- Medical Research Institute of New Zealand, Wellington, New Zealand.,National Heart and Lung Institute, Imperial College London, London, UK
| | - Pepa Bruce
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Holliday
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | | | | | - Allie Eathorne
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Arthur Grimes
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | - Matire Harwood
- Dept of General Practice and Primary Healthcare, University of Auckland, Auckland, New Zealand
| | - Thomas Hills
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Ciléin Kearns
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Kyley Kerse
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - John Martindale
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | | | - Lynn Riggs
- Motu Economic and Public Policy Research, Wellington, New Zealand
| | | | - Nick Shortt
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Katja Zazulia
- Medical Research Institute of New Zealand, Wellington, New Zealand
| | - Mark Weatherall
- Dept of Medicine, University of Otago, Wellington, New Zealand
| | - David McNamara
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand
| | - Catherine A Byrnes
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Dept of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Andrew Bush
- National Heart and Lung Institute, Imperial College London, London, UK.,Royal Brompton and Harefield NHS Foundation Trust, London, UK
| | - Stuart R Dalziel
- Starship Children's Health, Auckland District Health Board, Auckland, New Zealand.,Dept of Paediatrics, Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Richard Beasley
- Medical Research Institute of New Zealand, Wellington, New Zealand.,Capital and Coast District Health Board, Wellington, New Zealand.,School of Biological Sciences, Victoria University Wellington, Wellington, New Zealand
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Congleton J. Asthma: a disease of variability. Drug Ther Bull 2021; 59:50. [PMID: 33766921 DOI: 10.1136/dtb.2020.000069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Jo Congleton
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
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Yousif A, Forget A, Beauchesne MF, Lemière C, Dugré N, Fénélon-Dimanche R, Blais L. Development of an operational definition of treatment escalation in adults with asthma adapted to healthcare administrative databases: A Delphi study. Respir Med 2021; 185:106510. [PMID: 34182265 DOI: 10.1016/j.rmed.2021.106510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 06/11/2021] [Accepted: 06/13/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In recent years, there has been growing interest in studying asthma treatment escalation patterns in the real-world setting, particularly with the advent of expensive biologic therapies. Healthcare administrative claims databases can be used to study treatment escalation patterns at a population-level; however, the reported definitions for claims-based asthma treatment escalation are highly variable in the literature. OBJECTIVE The aim of this study was to develop an operational definition of treatment escalation in adults with asthma that can be applied to healthcare administrative data. METHODS A mixed-methods research design incorporating the Delphi process was used to establish an expert consensus for this definition. A multi-disciplinary expert panel participated in three iterative rounds of online questionnaires covering treatment escalation criteria inspired by a systematic review, which was conducted as part of this study. The final definition was constructed using criteria for which a 75% level of agreement was achieved among the experts. RESULTS We developed a claims-based treatment escalation definition that was adapted from the Global Initiative for Asthma (GINA) strategy. The definition comprised seven treatment steps, as well as escalation options for treatments that are not typically included in clinical guidelines. The definition also incorporated methods to identify treatments in severe asthma, such as oral corticosteroid maintenance therapy and chronic azithromycin use. CONCLUSIONS The operational definition of treatment escalation developed in this study bridges the gap between clinical guidelines and real-world clinical practice and lays the groundwork for future observational studies on treatment escalation patterns among patients with asthma.
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Affiliation(s)
- Alia Yousif
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
| | - Amélie Forget
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
| | - Marie-France Beauchesne
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux de l'Estrie-CHUS, Sherbrooke, QC, Canada.
| | - Catherine Lemière
- Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Faculty of Medicine, Université de Montreal, Montreal, QC, Canada.
| | - Nicolas Dugré
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
| | - Rébecca Fénélon-Dimanche
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada.
| | - Lucie Blais
- Faculty of Pharmacy, Université de Montréal, Montréal, QC, Canada; Research Centre, Centre Intégré Universitaire de santé et de services sociaux du Nord-de-l'île-de-Montréal, Montréal, QC, Canada; Endowment Pharmaceutical Chair, AstraZeneca in Respiratory Health, Canada.
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Stewart J, Kee F, Hart N. Using routinely collected primary care records to identify and investigate severe asthma: a scoping review. NPJ Prim Care Respir Med 2021; 31:1. [PMID: 33500422 PMCID: PMC7838272 DOI: 10.1038/s41533-020-00213-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Accepted: 11/24/2020] [Indexed: 12/30/2022] Open
Abstract
Shielding during the coronavirus pandemic has highlighted the potential of routinely collected primary care records to identify patients with 'high-risk' conditions, including severe asthma. We aimed to determine how previous studies have used primary care records to identify and investigate severe asthma and whether linkage to other data sources is required to fully investigate this 'high-risk' disease variant. A scoping review was conducted based on the Arksey and O'Malley framework. Twelve studies met all criteria for inclusion. We identified variation in how studies defined the background asthma cohort, asthma severity, control and clinical outcomes. Certain asthma outcomes could only be investigated through linkage to secondary care records. The ability of primary care records to represent the entire known asthma population is unique. However, a number of challenges need to be overcome if their full potential to accurately identify and investigate severe asthma is to be realised.
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Affiliation(s)
- Jonathan Stewart
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, BT12 6BA, UK.
| | - Frank Kee
- Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Block A, Royal Victoria Hospital, Belfast, BT12 6BA, UK
| | - Nigel Hart
- Centre for Medical Education, Queen's University Belfast, Whitla Medical Building, 97 Lisburn Road, Belfast, BT9 7BL, UK
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Gibbons DC, Aggarwal B, Fairburn-Beech J, Hinds D, Fletcher M, Bosnic-Anticevich S, Price D. Treatment patterns among non-active users of maintenance asthma medication in the United Kingdom: a retrospective cohort study in the Clinical Practice Research Datalink. J Asthma 2020; 58:793-804. [PMID: 32090642 DOI: 10.1080/02770903.2020.1728767] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Objective: To describe patient characteristics, treatment patterns and healthcare utilization (HCU) of non-active users of maintenance asthma medications in the United Kingdom.Methods: Retrospective, cohort analysis of patients with asthma, aged ≥ 6 years who were non-active users of maintenance therapy (no prescription for inhaled corticosteroids (ICS), combined ICS/long-acting beta agonists (ICS/LABA) or 'other' bronchodilatory therapies in last 12 months) were identified in the Clinical Practice Research Datalink (2012-2015) and followed-up for 2 years after a new prescription for an asthma maintenance medication (index date). Patient characteristics, most common maintenance treatment sequences and HCU were described.Results: 55,293 patients were identified (ICS: 46,297, ICS/LABA: 8,367; Other: 629). Mean age was 37 years and 56% were female. During follow-up, the most common treatment sequences across groups implied intermittent use, comprising periods of maintenance therapy interspersed with maintenance-free periods. During year 1 and year 2 of follow-up, the proportion of patients prescribed OCS was 19% and 13%, prescribed ≥ 4 short-acting bronchodilators (SABD) was 24% and 19%, having ≥ 3 asthma-related primary care consultations/year was 59% and 36% and experiencing ≥ 1 exacerbation/year was 15% and 11%, respectively.Conclusions: In previously non-active users of asthma maintenance medication subsequently commenced on maintenance therapy, intermittent use was common during the 2-year follow-up despite the potential need for regular use as evidenced by patient HCU and SABD usage patterns. This highlights the need for regular patient assessment and education on medication adherence to ensure appropriateness of prescribing to maintain asthma control.
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Affiliation(s)
- Daniel C Gibbons
- Value, Evidence and Outcomes Data, Methods and Analytics, GSK, Uxbridge, UK
| | - Bhumika Aggarwal
- Global Classic & Established Products, GSK, Singapore, Singapore
| | | | - David Hinds
- Real World Evidence & Epidemiology, GSK, Philadelphia, PA, USA
| | - Monica Fletcher
- GSK, London, UK.,Department of Primary Care, University of Edinburgh, Edinburgh, UK
| | - Sinthia Bosnic-Anticevich
- Quality Use of Respiratory Medicines Group, Woolcock Institute of Medical Research, University of Sydney, Sydney, NSW, Australia.,Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Central Sydney Local Area Health District, Sydney, NSW, Australia
| | - David Price
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK.,Observational and Pragmatic Research Institute, Singapore, Singapore
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