Real-Life Patterns of Exacerbations While on Inhaled Corticosteroids and Long-Acting Beta Agonists for Asthma over 15 Years.
Michael J McGeachieAlberta L WangSharon M LutzJoanne E SordilloScott T WeissKelan G TantisiraCarlos IribarrenMeng X LuAnn Chen WuPublished in: Journal of clinical medicine (2020)
Asthma affects more than 300 million people in the world, costs over $80 billion annually in the United States, and is efficaciously treated with inhaled corticosteroids (ICS). To our knowledge, no studies have examined the real-world effectiveness of ICS, including the combination therapy consisting of ICS and long-acting beta agonists (LABAs), and patterns of use over a 15-year time period. We used data from the Kaiser Permanente Northern California multi-ethnic Genetic Epidemiology Research on Adult Health and Aging (GERA) Cohort which comprises longitudinal electronic health record data of over 100,000 people. Data included longitudinal asthma-related events, such as ambulatory office visits, hospitalizations, emergency department (ED) visits, and fills of ICS and ICS-LABA combination. Asthma exacerbations were defined as an asthma-related ED visit, hospitalization, or oral corticosteroid (OCS) burst. We used an expected-value approach to determine ICS and ICS-LABA coverage over exacerbation events. We compared rates of exacerbation of subjects on ICS or ICS-LABAs to their own rates of exacerbation when off controller medications. We found ICS-LABA therapy had significant effects, reducing all types of exacerbations per day by a factor of 1.76 (95% CI (1.06, 2.93), p = 0.03) and, specifically, bursts per day by a factor of 1.91 (95% CI (1.04, 3.53), p = 0.037). In conclusion, ICS-LABA therapy was significantly associated with fewer asthma-related exacerbations in a large population of individuals with asthma who were followed for 15 years.
Keyphrases
- chronic obstructive pulmonary disease
- lung function
- electronic health record
- emergency department
- cystic fibrosis
- combination therapy
- healthcare
- allergic rhinitis
- gene expression
- randomized controlled trial
- public health
- cross sectional
- risk assessment
- systematic review
- mesenchymal stem cells
- stem cells
- risk factors
- dna methylation
- big data
- genome wide
- social media
- drug induced
- high frequency
- case control