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Tran TN, Heatley H, Rowell J, Chan JSK, Bourdin A, Chapaneri J, Emmanuel B, Gibson D, Jackson DJ, Menzies-Gow AN, Murray R, Skinner D, Price DB. Longitudinal patterns of intermittent oral corticosteroid therapy for asthma in the United Kingdom. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. GLOBAL 2024; 3:100225. [PMID: 38524787 PMCID: PMC10959664 DOI: 10.1016/j.jacig.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 10/10/2023] [Accepted: 11/14/2023] [Indexed: 03/26/2024]
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.
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Affiliation(s)
- Trung N. Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Md
| | - Heath Heatley
- Observational and Pragmatic Research Institute, Singapore
| | | | | | - Arnaud Bourdin
- Department of Respiratory Diseases, PhyMedExp, University of Montpellier, Montpellier, France
| | | | | | | | - David J. Jackson
- Guy’s and St Thomas’ NHS Trust and School of Immunology & Microbial Sciences, King’s College, London, United Kingdom
| | - Andrew N. Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals and School of Immunology & Microbial Sciences, King’s College, London, United Kingdom
- Respiratory and Immunology, BioPharmaceuticals Medical, AstraZeneca, Cambridge, United Kingdom
| | - Ruth Murray
- Optimum Patient Care, Cambridge, United Kingdom
| | - Derek Skinner
- Observational and Pragmatic Research Institute, Singapore
| | - David B. Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, United Kingdom
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Swed S, Sawaf B, Al-Obeidat F, Hafez W, Rakab A, Alibrahim H, Nasif MN, Alghalyini B, Zia Zaidi AR, Alshareef L, Alqatati F, Zamrath Zahir F, Ahmed AI, Alom M, Sultan A, AlMahmoud A, Bakkour A, Cherrez-Ojeda I. Asthma prevalence among United States population insights from NHANES data analysis. Sci Rep 2024; 14:8059. [PMID: 38580691 PMCID: PMC10997649 DOI: 10.1038/s41598-024-58429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Accepted: 03/29/2024] [Indexed: 04/07/2024] Open
Abstract
Asthma is a prevalent respiratory condition that poses a substantial burden on public health in the United States. Understanding its prevalence and associated risk factors is vital for informed policymaking and public health interventions. This study aims to examine asthma prevalence and identify major risk factors in the U.S. POPULATION Our study utilized NHANES data between 1999 and 2020 to investigate asthma prevalence and associated risk factors within the U.S. POPULATION We analyzed a dataset of 64,222 participants, excluding those under 20 years old. We performed binary regression analysis to examine the relationship of demographic and health related covariates with the prevalence of asthma. The study found that asthma affected 8.7% of the U.S. POPULATION Gender emerged as a significant factor, with 36.0% of asthma patients being male and 64.0% female (p < 0.001). Individuals aged 60 and older having the highest asthma prevalence at 34.0%. Non-Hispanic whites had the highest prevalence at 46.4%, followed by non-hispanic blacks at 26.0%. In contrast, Mexican Americans and other hispanic individuals had lower rates, at 9.6% and 9.0%, respectively. Females were 1.76 times more likely to have asthma than males (p < 0.001). Obese individuals had a 1.74 times higher likelihood of current asthma compared to underweight individuals (p < 0.001). Notably, both Non-Hispanic Whites and Non-Hispanic Blacks showed higher odds of current asthma compared to Mexican Americans (with adjusted odds ratios of 2.084 and 2.096, respectively, p < 0.001). The research findings indicate that asthma is prevalent in 8.7% of the U.S. POPULATION Our study highlights that individuals who are female, have low income, are obese, and smoke have the highest likelihood of being affected by asthma. Therefore, public health policies should prioritize addressing these risk factors in their preventive strategies.
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Affiliation(s)
- Sarya Swed
- Faculty of Medicine, Aleppo University, Aleppo, Syria.
| | - Bisher Sawaf
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | - Feras Al-Obeidat
- Associate Professor at the College of Technological Innovation at Zayed University, Abu Dhabi - Khalifa City, FF2-0-032; Abu Dhabi Campus, Abu Dhabi, UAE
| | - Wael Hafez
- NMC Royal Hospital, 16Th Street, Khalifa City, Abu Dhabi, UAE
- Assistant Professor; Internal Medicine Department, Medical Research and Clinical Studies Institute,, The National Research Centre, 33 El Buhouth St, Ad Doqi, Dokki, Cairo Governorate 12622, Cairo, Egypt
| | | | | | | | - Baraa Alghalyini
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul Rehman Zia Zaidi
- Department of Family and Community Medicine, College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | | | - Fadel Alqatati
- Department of Internal Medicine, Hamad Medical Corporation, Doha, Qatar
| | | | | | - Mulham Alom
- Southern Illinois University School of Medicine, Springfield, IL, USA
| | - Anas Sultan
- Department of Internal Medicine, Pulmonary Division, King Faisal Specialist Hospital and Research Centre, Jeddah, Saudi Arabia
| | - Abdullah AlMahmoud
- Internal Medicine, Gastroenterology, Hepatology; Dr. Soliman Fakeeh Hospital (DSFH), Jeddah, Saudi Arabia
| | | | - Ivan Cherrez-Ojeda
- Universidad Espíritu Santo, Samborondón, Ecuador
- Respiralab Research Group, Guayaquil, Ecuador
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Cvetkovski B, Muscat D, Bousquet J, Cabrera M, House R, Katsoulotos G, Lourenco O, Papadopoulos N, Price DB, Rimmer J, Ryan D, Smith P, Yan K, Bosnic-Anticevich S. The future of allergic rhinitis management: A partnership between healthcare professionals and patients. World Allergy Organ J 2024; 17:100873. [PMID: 38463017 PMCID: PMC10924206 DOI: 10.1016/j.waojou.2024.100873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/12/2024] [Accepted: 01/16/2024] [Indexed: 03/12/2024] Open
Abstract
Allergic rhinitis (AR) is a chronic respiratory condition that internationally continues to be burdensome and impacts quality of life. Despite availability of medicines and guidelines for healthcare providers for the optimal management of AR, optimisation of its management in the community continues to be elusive. The reasons for this are multi-faceted and include both environmental and healthcare related factors. One factor that we can no longer ignore is that AR management is no longer limited to the domain of healthcare provider and that people with AR make their own choices when choosing how to manage their condition, without seeking advice from a health care provider. We must build a bridge between healthcare provider knowledge and guidelines and patient decision-making. With this commentary, we propose that a shared decision-making approach between healthcare professionals and people with AR be developed and promoted, with a focus on patient health literacy. As custodians of AR knowledge, we have a responsibility to ensure it is accessible to those that matter most-the people with AR.
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Affiliation(s)
| | | | | | | | - Rachel House
- Woolcock Institute of Medical Research, Australia
| | - Gregory Katsoulotos
- The University of Notre Dame Australia and The University of Technology, Australia
| | | | | | | | | | - Dermot Ryan
- University of Aberdeen Academic Primary Care Research Group, UK
| | - Pete Smith
- Griffith University - Gold Coast Campus, Australia
| | - Kwok Yan
- Royal Prince Alfred Hospital, Australia
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Heatley H, Tran TN, Bourdin A, Menzies-Gow A, Jackson DJ, Maslova E, Chapaneri J, Skinner D, Carter V, Chan JSK, Ariti C, Haughney J, Price DB. Observational UK cohort study to describe intermittent oral corticosteroid prescribing patterns and their association with adverse outcomes in asthma. Thorax 2023; 78:860-867. [PMID: 36575040 PMCID: PMC10447390 DOI: 10.1136/thorax-2022-219642] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2022] [Accepted: 11/29/2022] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Oral corticosteroids (OCS) for asthma are associated with increased risks of developing adverse outcomes (adverse outcomes); no previous study has focused exclusively on intermittent OCS use. METHODS This historical (2008-2019) UK cohort study using primary care medical records from two anonymised, real-life databases (OPCRD and CPRD) included patients aged≥4 years with asthma receiving only intermittent OCS. Patients were indexed on their first recorded intermittent OCS prescription for asthma and categorised by OCS prescribing patterns: one-off (single), less frequent (≥90 day gap) and frequent (<90 day gap). Non-OCS patients matched 1:1 on gender, age and index date served as controls. The association of OCS prescribing patterns with OCS-related AO risk was studied, stratified by age, Global Initiative for Asthma (GINA) 2020 treatment step, and pre index inhaled corticosteroid (ICS) and short-acting β2-agonist (SABA) prescriptions using a multivariable Cox-proportional hazard model. FINDINGS Of 476 167 eligible patients, 41.7%, 26.8% and 31.6% had one-off, less frequent and frequent intermittent OCS prescribing patterns, respectively. Risk of any AO increased with increasingly frequent patterns of intermittent OCS versus non-OCS (HR; 95% CI: one-off 1.19 (1.18 to 1.20), less frequent 1.35 (1.34 to 1.36), frequent 1.42 (1.42 to 1.43)), and was consistent across age, GINA treatment step and ICS and SABA subgroups. The highest risks of individual OCS-related adverse outcomes with increasingly frequent OCS were for pneumonia and sleep apnoea. CONCLUSION A considerable proportion of patients with asthma receiving intermittent OCS experienced a frequent prescribing pattern. Increasingly frequent OCS prescribing patterns were associated with higher risk of OCS-related adverse outcomes. Mitigation strategies are needed to minimise intermittent OCS prescription in primary care.
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Affiliation(s)
- Heath Heatley
- Observational and Pragmatic Research Institute, Singapore
| | - Trung N Tran
- BioPharmaceuticals Medical, AstraZeneca, Gaithersburg, Maryland, USA
| | - Arnaud Bourdin
- Department of Respiratory Diseases, PhyMedExp, University of Montpellier, Montpellier, France
| | - Andrew Menzies-Gow
- UK Severe Asthma Network and National Registry, Royal Brompton & Harefield Hospitals and School of Immunology & Microbial Sciences, King's College, London, UK
| | - David J Jackson
- UK Severe Asthma Network and National Registry, Guy's and St Thomas' NHS Trust and Division of Asthma, Allergy & Lung Biology, King's College, London, UK
| | | | | | - Derek Skinner
- Observational and Pragmatic Research Institute, Singapore
| | | | | | - Con Ariti
- Observational and Pragmatic Research Institute, Singapore
| | | | - David B Price
- Observational and Pragmatic Research Institute, Singapore
- Centre of Academic Primary Care, Division of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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Larcombe AN, Chivers EK, Huxley RR, Musk A(BW, Franklin PJ, Mullins BJ. Electronic Cigarette Usage Patterns and Perceptions in Adult Australians. TOXICS 2023; 11:290. [PMID: 36977055 PMCID: PMC10056955 DOI: 10.3390/toxics11030290] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/17/2023] [Accepted: 03/17/2023] [Indexed: 06/18/2023]
Abstract
Despite their increasing popularity, and Australia's unique regulatory environment, how and why Australian adults use e-cigarettes and their perceptions of their safety, efficacy and regulation have not been extensively reported before. In this study, we screened 2217 adult Australians with the aim of assessing these questions in a sample of current or former e-cigarette users. A total of 505 out of 2217 respondents were current or former e-cigarette users, with only these respondents completing the full survey. Key findings of this survey included the high proportion of respondents who indicated they were currently using e-cigarettes (307 out of 2217 = 13.8%), and the high proportion of current e-cigarette users that were also smokers (74.6%). The majority of respondents used e-liquids containing nicotine (70.3%), despite it being illegal in Australia without a prescription, and the majority bought their devices and liquids in Australia (65.7%). Respondents reported using e-cigarettes in a variety of places, including inside the home, inside public places (where it is illegal to smoke tobacco cigarettes), and around other people-which has implications for second and third hand exposures. A significant proportion of current e-cigarette users (30.6%) thought that e-cigarettes were completely safe to use long-term, although in general, there was a large amount of uncertainty/ambivalence with respect to perceptions of e-cigarette safety and efficacy as smoking cessation tools. This study shows that e-cigarette use is common in Australia, and that appropriate dissemination of unbiased research findings on their safety and efficacy in smoking cessation is urgently required.
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Affiliation(s)
- Alexander N. Larcombe
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
| | - Emily K. Chivers
- Respiratory Environmental Health, Wal-yan Respiratory Research Centre, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Rachel R. Huxley
- The George Institute for Global Health, University of New South Wales, Newtown, NSW 2042, Australia
- Faculty of Health, Deakin University, Burwood, VIC 3125, Australia
| | - Arthur (Bill) W. Musk
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
- Department of Respiratory Medicine, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Peter J. Franklin
- School of Population and Global Health, University of Western Australia, Crawley, WA 6009, Australia
| | - Benjamin J. Mullins
- Occupation, Environment and Safety, School of Population Health, Curtin University, Perth, WA 6845, Australia
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Roberts E. Oral Corticosteroids for Patients with Eosinophilic Diseases: An Expert Panel View on Use, Overuse, and Strategies to Reduce Use. EUROPEAN MEDICAL JOURNAL 2023. [DOI: 10.33590/emj/10303904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/18/2023] Open
Abstract
Severe asthma (SA), chronic rhinosinusitis with nasal polyps (CRSwNP), and eosinophilic granulomatosis with polyangiitis (EGPA) are three conditions driven by IL-5 and eosinophilic inflammation. As these conditions have high use of healthcare services, as well as lifestyle and psychological burdens, safe treatment to achieve optimal control is key. In all three conditions, as for many other eosinophilic diseases (ED), oral corticosteroids (OCS) are often used for both acute and maintenance treatment where disease activity is high. While, in general, OCS are very effective, their use is limited by a well-recognised high potential for adverse effects (AE). Moreover, cumulative exposure to OCS may not be acknowledged in many patients, especially for those predominantly treated in primary care, exposing patients to potentially damaging long-term OCS-related AEs. To discuss the use of OCS for these eosinophilic diseases, as well as to provide guidance on how to help limit their use, a board of European experts within each field was gathered. The experts completed questionnaires regarding treatment and referral pathways for patients with SA, CRSwNP, or EGPA; then, in an online meeting, discussed a number of issues in regard to OCS use. Here, the authors present the key recommendations from the expert advisory panel alongside some background to these conditions regarding treatment with OCS.
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