TY - JOUR
T1 - Relationship between adherence to inhaled corticosteroids and poor outcomes among adults with asthma
AU - Williams, L. Keoki
AU - Pladevall, Manel
AU - Xi, Hugo
AU - Peterson, Edward L.
AU - Joseph, Christine
AU - Lafata, Jennifer Elston
AU - Ownby, Dennis R.
AU - Johnson, Christine C.
N1 - Funding Information:
Supported in part by grants from the Fund for Henry Ford Hospital, the National Institute of Allergy and Infectious Diseases (R01AI50681), and the National Heart, Lung, and Blood Institute (R01HL068971).
PY - 2004/12
Y1 - 2004/12
N2 - Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence. We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use. Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [R] = -0.159), the number of fills of an oral steroid (R = -0.179), and the total days' supply of oral steroid (R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction). Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.
AB - Regular use of inhaled corticosteroids (ICSs) can improve asthma symptoms and prevent exacerbations. However, overall adherence is poor among patients with asthma. To estimate the proportion of poor asthma-related outcomes attributable to ICS nonadherence. We retrospectively identified 405 adults age 18 to 50 years who had asthma and were members of a large health maintenance organization in southeast Michigan between January 1, 1999, and December 31, 2001. Adherence indices were calculated by using medical records and pharmacy claims. The main outcomes were the number of asthma-related outpatient visits, emergency department visits, and hospitalizations, as well as the frequency of oral steroid use. Overall adherence to ICS was approximately 50%. Adherence to ICS was significantly and negatively correlated with the number of emergency department visits (correlation coefficient [R] = -0.159), the number of fills of an oral steroid (R = -0.179), and the total days' supply of oral steroid (R = -0.154). After adjusting for potential confounders, including the prescribed amount of ICS, each 25% increase in the proportion of time without ICS medication resulted in a doubling of the rate of asthma-related hospitalization (relative rate, 2.01; 95% CI, 1.06-3.79). During the study period, there were 80 asthma-related hospitalizations; an estimated 32 hospitalizations would have occurred were there no gaps in medication use (60% reduction). Adherence to ICS is poor among adult patients with asthma and is correlated with several poor asthma-related outcomes. Less than perfect adherence to ICS appears to account for the majority of asthma-related hospitalizations.
KW - Adherence
KW - asthma
KW - attributable risk
KW - emergency department visits
KW - hospitalizations
KW - inhaled corticosteroids
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U2 - 10.1016/j.jaci.2004.09.028
DO - 10.1016/j.jaci.2004.09.028
M3 - Article
C2 - 15577825
AN - SCOPUS:9644291519
SN - 0091-6749
VL - 114
SP - 1288
EP - 1293
JO - Journal of Allergy and Clinical Immunology
JF - Journal of Allergy and Clinical Immunology
IS - 6
ER -