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Yoo KH, Kim SH, Kim SH, Moon JY, Park HW, Chang YS, Beekman MJ. Short-acting β2-agonist prescriptions in patients with asthma: findings from the South Korean cohort of SABINA III. Korean J Intern Med 2024; 39:123-136. [PMID: 38057957 PMCID: PMC10790050 DOI: 10.3904/kjim.2023.086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 07/31/2023] [Accepted: 08/11/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND/AIMS Despite short-acting β2-agonist (SABA) overuse being associated with poor asthma outcomes, data on SABA use in South Korea is scarce. Herein, we describe prescription patterns of SABA and other asthma medications in patients from the South Korean cohort of the SABA use IN Asthma (SABINA) III study. METHODS This study included patients with asthma aged ≥ 12 years, who had ≥ 3 consultations with the same healthcare provider, and medical records containing data for ≥ 12 months prior to the study visit. Patients were classified by investigator-defined asthma severity (per 2017 Global Initiative for Asthma recommendations) and practice type (primary or specialist care). Data on disease characteristics, asthma treatments, and clinical outcomes in the 12 months before the study visit were collected using electronic case report forms. RESULTS Data from 476 patients (mean age, 55.4 years; female, 63.0%) were analyzed. Most patients were treated by specialists (83.7%) and had moderate-to-severe asthma (91.0%). Overall, 7.6% of patients were prescribed ≥ 3 SABA canisters (defined as over-prescription). In patients prescribed SABA in addition to maintenance therapy, 47.4% were over-prescribed SABA. Most patients (95.4%) were prescribed a fixed-dose combination of an inhaled corticosteroid and a long-acting β2-agonist as maintenance therapy. Although asthma was well-controlled/partly-controlled in 91.6% of patients, 29.6% experienced ≥ 1 severe asthma exacerbation. CONCLUSION SABA over-prescription was reported in nearly 50% of patients prescribed SABA in addition to maintenance therapy, underscoring the need to align clinical practices with the latest evidence-based recommendations and educate physicians and patients on appropriate SABA use.
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Affiliation(s)
- Kwang-Ha Yoo
- Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Konkuk University Medical Center, Konkuk University School of Medicine, Seoul,
Korea
| | - Sang-Ha Kim
- Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju,
Korea
| | - Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Ji-Yong Moon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul,
Korea
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul,
Korea
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
- Institute of Allergy and Clinical Immunology, Seoul National University Medical Research Center, Seoul,
Korea
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam,
Korea
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Fukuda Y, Homma T, Sagara H. Clinical inertia in asthma. NPJ Prim Care Respir Med 2023; 33:34. [PMID: 37838773 PMCID: PMC10576819 DOI: 10.1038/s41533-023-00356-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Accepted: 10/06/2023] [Indexed: 10/16/2023] Open
Abstract
Despite advances in pharmaceutical treatment in recent years, a relatively high proportion of patients with asthma do not have adequate asthma control, causing chronic disability, poor quality of life, and multiple emergency department visits and hospitalizations. A multifaceted approach is needed to overcome the problems with managing asthma, and clinical inertia (CI) is a crucial concept to assist with this approach. It divides clinical inertia into three main categories, which include healthcare provider-related, patient-related, and healthcare system-related CI. The strategies to overcome these CI are complex, and the M-GAP approach, which combines a multidisciplinary approach, dissemination of guidelines, utilization of applications, and development and promotion of low-cost prescriptions, will help clinicians.
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Affiliation(s)
- Yosuke Fukuda
- Department of Medicine, Division of Respiratory Medicine, Yamanashi Red Cross Hospital, 6663-1 Funatsu, Fujikawaguchiko-machi, Yamanashi, Japan.
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan.
| | - Tetsuya Homma
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
| | - Hironori Sagara
- Department of Medicine, Division of Respiratory Medicine and Allergology, Showa University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo, Japan
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Dhar R, Rhee CK, Perng DW, Fukunaga K, Ip MSM, Juthong S, Koh MS, Li J, Sharma S, Wiyono WH. The burden of systemic corticosteroid use in asthma management in Asia. Respirology 2023. [PMID: 37301540 DOI: 10.1111/resp.14533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 05/03/2023] [Indexed: 06/12/2023]
Abstract
For most patients, asthma can be effectively managed using inhaled medications. However, patients who have severe and/or uncontrolled asthma, or who experience exacerbations, may require systemic corticosteroids (SCSs) to maintain asthma control. Although SCS are highly effective in this regard, even modest exposure to these medications can increase the risk for long-term, adverse health outcomes, such as type 2 diabetes, renal impairment, cardiovascular disease and overall mortality. Clinical and real-world data from studies investigating asthma severity, control and treatment practices around the globe have suggested that SCS are overused in asthma management, adding to the already substantial healthcare burden experienced by patients. Throughout Asia, although data on asthma severity, control and SCS usage are limited and vary widely among countries, available data strongly suggest a pattern of overuse consistent with the broader global trend. Coordinated changes at the patient, provider, institutional and policy levels, such as increasing disease awareness, promoting better adherence to treatment guidelines and increasing availability of safe and effective alternatives to SCS, are likely necessary to reduce the SCS burden for patients with asthma in Asia.
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Affiliation(s)
- Raja Dhar
- Department of Pulmonology, CK Birla Group of Hospitals, Kolkata, West Bengal, India
| | - Chin Kook Rhee
- Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of South Korea, Seoul, South Korea
| | - Diahn-Warng Perng
- Department of Chest Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Koichi Fukunaga
- Department of Pulmonary Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Mary Sau-Man Ip
- Department of Medicine, University of Hong Kong, Hong Kong, China
| | - Siwasak Juthong
- Department of Internal Medicine, Faculty of Medicine, Prince of Songkla University, Hat Yai, Songkhla, Thailand
| | - Mariko Siyue Koh
- Department of Respiratory and Critical Care Medicine, Singapore General Hospital, Singapore, Singapore
| | - Jing Li
- Allergy and Clinical Immunology Department, State Key Laboratory of Respiratory Disease, The First Affiliated Hospital, Guangzhou Medical University, Guangzhou, China
| | - Shubham Sharma
- Heart and Lung Transplant Unit, Yashoda Hospitals, Secunderabad, India
| | - Wiwien Heru Wiyono
- Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Indonesia, Persahabatan Hospital, Jakarta, Indonesia
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Ozoh OB, Dede S, Eze J, Mortimer K, Chinouya M. Nigerian doctors’ experiences of guideline-based asthma management: a qualitative study. JOURNAL OF GLOBAL HEALTH REPORTS 2022. [DOI: 10.29392/001c.56661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background The Global Initiative for Asthma (GINA) report sets out an updated evidence-based strategy for asthma management. Little is known about how this report is perceived and implemented in low-income and middle-income countries (LMICs) like Nigeria. We explored the experiences of asthma management as informed by the current GINA guideline among doctors in Lagos, Nigeria. Methods Using a qualitative research approach, in-depth interviews were conducted among doctors in Lagos, Nigeria to explore their experiences of asthma management in the context of the current GINA report. The thematic framework approach was used for data analysis. Results Eleven doctors aged 28-46 years (five general practitioners (GPs) and six family physicians (FPs) took part. Four overarching themes were identified: (i) knowledge of, and attitude towards the GINA strategy – whilst most doctors were aware of the existence of the GINA report, there was limited knowledge about its content including current recommendations for mild asthma treatment; (ii) asthma diagnosis and treatment – there was limited access to lung function testing facilities, and its role in asthma diagnosis was underappreciated; (iii) barriers to managing asthma according to GINA recommendations – these included complexity of the GINA report, unavailability and unaffordability of asthma medicines and poor patient adherence to medications, driven by socio-cultural factors; and (iv) enablers of GINA-recommended asthma management – improvement in asthma education for doctors and the general population and better access to diagnostic tests and medicines. Conclusions Whilst there was awareness of the existence of the GINA report, there was limited knowledge about its content and several barriers to its implementation were reported. Education about the GINA report, investment in diagnostic and treatment services and simplification of recommendations were identified as possible solutions.
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Affiliation(s)
- Obianuju B. Ozoh
- Lagos University Teaching Hospital, Nigeria
- Faculty of Clinical Sciences, College of Medicine, University of Lagos, Nigeria
| | | | - Joy Eze
- Faculty of Medical Sciences, College of Medicine, University of Nigeria, Enugu, Nigeria
| | - Kevin Mortimer
- University of Cambridge, Cambridge, United Kingdom
- Liverpool University Hospitals NHS Foundation Trust, United Kingdom
| | - Martha Chinouya
- Liverpool School of Tropical Medicine, Liverpool, United Kingdom
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Choi NK, Shantakumar S, Kim MS, Lee CH, Cheng WY, Bobbili P, Yang BR, Lee J, Hinds D, Duh MS, Korves C, Park HW. Real-world Treatment Patterns, Outcomes, and Healthcare Resource Utilization in Newly Treated Korean Patients With Asthma: A Retrospective Cohort Study. ALLERGY, ASTHMA & IMMUNOLOGY RESEARCH 2022; 14:220-232. [PMID: 35255539 PMCID: PMC8914610 DOI: 10.4168/aair.2022.14.2.220] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 10/13/2021] [Accepted: 12/07/2021] [Indexed: 11/22/2022]
Abstract
Purpose Although asthma treatment guidelines recommend regular inhaled medication, real-world treatment patterns and outcomes in South Korea have not been examined. We examined real-world treatment patterns and outcomes among patients treated for asthma in South Korea. Methods This retrospective cohort study utilized data from the South Korean National Health Insurance database (2013–2016). Newly treated patients with asthma aged ≥18 years without history of chronic obstructive pulmonary disease were included. Initial and maintenance medication prescriptions were examined. Treatment discontinuation and switch were described. Asthma exacerbation rates, poor asthma control, and healthcare resource utilization (HRU) were compared between maintenance treatment groups (inhaled versus oral) using adjusted incidence rate ratios (aIRR) and hazard ratios (aHR). Results Overall, 1,054,707 patients initiated any asthma medication; 37,868 patients initiated inhaled (n = 9,983, 26.4%) or oral (n = 27,885, 73.6%) maintenance medication. More patients initiating inhaled versus oral asthma medication discontinued treatment within 12 months (94.4% vs. 86.3%; P < 0.0001). Patients treated with inhaled and oral medication switched treatment (2.5% and 2.3%; P = 0.4160, respectively). Patients initiating inhaled medication had significantly lower rates of asthma exacerbation (aIRR, 0.52; 95% CI, 0.39–0.69), lack of asthma control (aHR, 0.55; 95% CI, 0.48–0.62; P < 0.0001), all-cause and asthma-related HRU versus oral medication. Conclusions Despite current asthma guidelines, more patients in South Korea were prescribed oral than inhaled medications, resulting in suboptimal asthma management and increased HRU. This study highlights the need to reduce oral corticosteroid prescriptions for optimized treatment in asthma management.
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Affiliation(s)
- Nam-Kyong Choi
- Department of Health Convergence, Ewha Womans University, Seoul, Korea
| | - Sumitra Shantakumar
- Epidemiology and Health Economics, Greater China & Intercontinental Region, Medical Affairs, GlaxoSmithKline plc. Vaccines, Singapore
| | - Mi-Sook Kim
- Department of Preventive Medicine, Seoul National University, Seoul, Korea
| | - Chang-Hoon Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | | | | | - Bo Ram Yang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Korea
| | - Joongyub Lee
- Department of Prevention and Management, Inha University Hospital, School of Medicine, Inha University, Incheon, Korea
| | - David Hinds
- Real World Evidence and Epidemiology, GlaxoSmithKline plc., Collegeville, PA, USA
| | | | | | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
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Kim SH, Lee H, Park SY, Park SY, Song WJ, Kim JH, Park HW, Cho YS, Yoon HJ. The Korean Severe Asthma Registry (KoSAR): real world research in severe asthma. Korean J Intern Med 2022; 37:249-260. [PMID: 35184515 PMCID: PMC8925953 DOI: 10.3904/kjim.2021.403] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Accepted: 12/17/2021] [Indexed: 11/27/2022] Open
Abstract
Severe asthma constitutes a serious health burden with significant morbidity and socioeconomic costs. The development and introduction of new biologics targeting type 2 inflammation changed the paradigm for management of severe asthma and initiated a biological era. These changes impose a challenge to clinicians in managing difficult-to-treat and severe asthma. To understand the characteristics and heterogeneity of severe asthma and to develop a better strategy to manage it, the Korean Academy of Asthma, Allergy and Clinical Immunology, Working Group on Severe Asthma, has organized the Korean Severe Asthma Registry (KoSAR). In this review, we describe the challenges of severe asthma management regarding diagnosis, disease burden, heterogeneity, guidelines, and organization of severe asthma clinics. This review also examines the current global activities of national and regional registries and study groups. In addition, we present the KoSAR vision and organization and describe the findings of KoSAR in comparison with those of other countries.
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Affiliation(s)
- Sang-Heon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - Hyun Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
| | - So-Young Park
- Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul,
Korea
| | - So Young Park
- Department of Internal Medicine, Eulji General Hospital, Eulji University School of Medicine, Seoul,
Korea
| | - Woo-Jung Song
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Joo-Hee Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang,
Korea
| | - Heung-Woo Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul,
Korea
| | - You Sook Cho
- Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,
Korea
| | - Ho Joo Yoon
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul,
Korea
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Daniels L, Barker S, Chang YS, Chikovani T, DunnGalvin A, Gerdts JD, Gerth Van Wijk R, Gibbs T, Villarreal-Gonzalez RV, Guzman-Avilan RI, Hanna H, Hossny E, Kolotilina A, Ortega Martell JA, Pacharn P, de Lira Quezada CE, Sibanda E, Stukus D, Tham EH, Venter C, Gonzalez-Diaz SN, Levin ME, Martin B, Munblit D, Warner JO. Harmonizing allergy care-integrated care pathways and multidisciplinary approaches. World Allergy Organ J 2021; 14:100584. [PMID: 34820045 PMCID: PMC8591185 DOI: 10.1016/j.waojou.2021.100584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 08/08/2021] [Accepted: 08/26/2021] [Indexed: 01/14/2023] Open
Abstract
There is a wide time gap between the publication of evidence and the application of new knowledge into routine clinical practice. The consequence is sub-optimal outcomes, particularly concerning for long-term relapsing/remitting conditions such as allergic diseases. In response, there has been a proliferation of published guidelines which systematically review evidence for the gold-standard management of most allergic disorders. However, this has not necessarily been followed by improved outcomes, partly due to a lack of coordination across the patient pathway. This has become known as the "second translational gap". A proposed solution is the development and implementation of integrated care pathways (ICPs) to optimize patient outcomes, with the notion that evidence-based medicine requires evidence-based implementation. ICP implementation is shown to improve short-term outcomes for acute conditions and routine surgery, including reduced length of hospital stay, improved documentation and improved patient safety. However, this improvement is not reflected in patient experience or patient-centered functional outcomes. The implementation of life-long, cost-effective interventions within comprehensive pathways requires a deep appreciation for complexity within allergy care. We promote an evidence-based methodology for the implementation of ICPs for allergic disorders in which all stakeholders in allergy care are positioned equally and encouraged to contribute, particularly patients and their caregivers. This evidence-based process commences with scoping the unmet needs, followed by stakeholder mapping. All stakeholders are invited to meetings to develop a common vision and mission through the generation of action/effect diagrams which helps build concordance across the agencies. Dividing the interventions into achievable steps and reviewing with plan/do/study/act cycles will gradually modify the pathway to achieve the best outcomes. While the management guidelines provide the core knowledge, the key component of implementation involves education, training, and support of all healthcare professionals (HCPs), patients and their caregivers. The pathways should define the level of competence required for each clinical task. It may be useful to leave the setting of care delivery or the specific HCP involved undefined to account for variable patterns of health service delivery as well as local socioeconomic, ethnic, environmental, and political imperatives. In all cases, where competence is exceeded, it is necessary to refer to the next stage in the pathway. The success and sustainability of ICPs would ideally be judged by patient experience, health outcomes, and health economics. We provide examples of successful programs, most notably from Finland, but recommend that further research is required in diverse settings to optimize outcomes worldwide.
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Affiliation(s)
- Lydia Daniels
- Faculty of Medicine, Imperial College London, London, UK
| | - Sally Barker
- Faculty of Medicine, Imperial College London, London, UK
| | - Yoon-Seok Chang
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Republic of Korea
| | - Tinatin Chikovani
- Department of Immunology, Tbilisi State Medical University, Tbilisi, Georgia
| | - Audrey DunnGalvin
- Applied Psychology and Paediatrics and Child Health, University College Cork, Cork, Ireland
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Roy Gerth Van Wijk
- Section of Allergology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, the Netherlands
| | - Trevor Gibbs
- Association for Medical Education in Europe (AMEE), Dundee, Scotland, UK
- Independant Consultant in Primary Care and Medical Education, UK
| | - Rosalaura V. Villarreal-Gonzalez
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Rosa I. Guzman-Avilan
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | | | - Elham Hossny
- Pediatric Allergy and Immunology Unit, Children's Hospital, Ain Shams University, Cairo, Egypt
| | - Anastasia Kolotilina
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | | | - Punchama Pacharn
- Department of Pediatrics, Siriraj Hospital, Mahidol University, Bangkok, Thailand
| | - Cindy E. de Lira Quezada
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Elopy Sibanda
- Asthma, Allergy and Immune Dysfunction Clinic, Twin Palms Medical Centre, Harare, Zimbabwe
- Department of Pathology, Medical School, National University of Science and Technology, Bulawayo, Zimbabwe
| | - David Stukus
- Division of Allergy and Immunology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Elizabeth Huiwen Tham
- Department of Paediatrics, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- Khoo Teck Puat-National University Children's Medical Institute, National University Hospital, National University Health System, Singapore, Singapore
- Human Potential Translational Research Programme, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Carina Venter
- Section of Allergy and Immunology, University of Colorado Denver School of Medicine, Children's Hospital Colorado, Colorado, USA
| | - Sandra N. Gonzalez-Diaz
- Regional Center of Allergy and Clinical Immunology, University Hospital “Dr. Jose Eleuterio Gonzalez”, Faculty of Medicine, Autonomous University of Nuevo León, Monterrey, Mexico
| | - Michael E. Levin
- Division of Paediatric Allergy, Department of Paediatrics, University of Cape Town, Cape Town, South Africa
| | - Bryan Martin
- Division of Allergy and Immunology, Department of Otolaryngology, The Ohio State University, Columbus, OH, USA
| | - Daniel Munblit
- Department of Paediatrics and Paediatric Infectious Diseases, Institute of Child's Health, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
- Solov'ev Research and Clinical Center for Neuropsychiatry, Moscow, Russia
| | - John O. Warner
- Inflammation, Repair and Development Section, National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
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