A primary care database study of asthma among patients with and without opioid use disorders

Abstract

Substance misuse is associated with poor asthma outcome and death. People with opioid use disorder (OUD) may be at particular risk, however, there have been no case-control studies of asthma care and outcomes in this patient group. A primary care database study of patients with asthma aged 16-65 years was conducted using a matched case-control methodology. The dataset comprised 275,151 adults with asthma, of whom 459 had a clinical code indicating a lifetime history of OUD. Cases with a history of OUD were matched to controls 1:3 by age, gender, smoking status and deprivation index decile. Attendance at annual review (30%) and for immunisation (25%) was poor amongst the overall matched study population (N = 1832). Compared to matched controls, cases were less likely to have attended for asthma review during the previous 12 months (OR = 0.60, 95% CI 0.45-0.80) but had similar immunisation rates. Higher rates of ICS (OR = 1.50, 1.13-1.98) and oral prednisolone use (OR = 1.71, 1.25-2.40) were seen amongst those with a history of OUD and 7.2% had a concurrent diagnosis of COPD (OR = 1.86, 1.12-2.40). We found that people with asthma and a history of OUD have worse outcomes on several commonly measured metrics of asthma care. Further research is required to identify reasons for these findings, the most effective strategies to help this vulnerable group access basic asthma care, and to better understand long-term respiratory outcomes.

Risk of asthma exacerbation associated with opioid and nonopioid analgesic use in children with current asthma

“…[40][41][42][43] The risk of asthma associated with opioid use was also reported in a recent case-control study among adults with opioid use disorder. 44 Our findings bridge the gap and clarify the safety concern associated with the use of prescription analgesics by children with asthma for pediatric practitioners who often need to prescribe opioid analgesics, such as surgeons, ED physicians, and dentists. The findings suggest that the asthma exacerbation event following a prescription analgesic administration…”

Prescriptions of opioid-containing drugs in patients with chronic cough

“…For example, asthma and bronchitis, which can cause cough, have been speculated to be occasional complications of opiate use. 19 , 20 Oliver et al 21 reported, from a primary care database of 275,151 adults with asthma, that higher usage of inhaled corticosteroids or oral prednisolone was seen among those with a history of opioid use disorder. Similarly, Mehta et al 22 found that prescription of methadone was a smoking-independent predictor of chronic obstructive pulmonary disease and asthma.…”

Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

“…cific medication-SUD relationships, such as the higher risk of opioid use among people using asthma inhalers [37]. The number of medications may plausibly represent a proximal measure of disease burden; however, given the inclusion of a disease severity measure, we hypothesize that this relationship reflects an added level of comfort with taking medications.…”