Burden of asthma among patients adherent to ICS/LABA: A real-world study

Davis, Jill; Trudo, Frank; Siddall, James; Small, Mark

doi:10.1080/02770903.2018.1455858

Cited by 29 publications

(35 citation statements)

References 26 publications

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“…The reported employment of 32% in this study cohort of patients with ILD is lower than rates reported in other chronic pulmonary disorders. The employment rate ranged from 42% to 55% and 49% to 75% in national and multinational cross-sectional surveys of asthma and COPD, respectively [25][26][27][28][29][30][31][32] ; however, direct comparison to our findings is limited by different population demographic characteristics. The impact of ILD on workplace productivity was greater than that reported in a 2017 publication from the Canadian Cohort of Obstructive Lung Disease (CanCOLD) study, which reported workplace productivity loss in 30% of employed patients with COPD who had an average age of 60 years and high symptom burden (COPD Assessment Test score $ 10).…”

Section: Discussionmentioning

confidence: 92%

Costs of Workplace Productivity Loss in Patients With Fibrotic Interstitial Lung Disease

Algamdi

Sadatsafavi

Fisher

et al. 2019

Chest

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BACKGROUND: Fibrotic interstitial lung diseases (ILDs) are highly morbid chronic disorders that frequently occur in working age individuals. The goal of this study was to determine workplace productivity loss, its determinants, and its estimated costs in patients with fibrotic ILD. METHODS: Patients with idiopathic pulmonary fibrosis, chronic hypersensitivity pneumonitis, idiopathic nonspecific interstitial pneumonia, or unclassifiable ILD were identified from the six-center Canadian Registry for Pulmonary Fibrosis (CARE-PF). The Work Productivity and Activity Impairment questionnaire was used to determine health-related productivity loss. Independent predictors of low workplace productivity were identified by using multivariate regression. Patient data were compared with Canadian population census data. The average productivity loss (hours per week) and the individual's hourly wage were used to estimate the costs of productivity loss. RESULTS: Of 650 eligible patients, 148 (23%) were employed. Productivity loss was reported by 55% of employed patients with an average productivity loss of 7.8 AE 0.9 h per week (2.3 AE 0.6 h per week related to absenteeism and 5.5 AE 0.6 h per week related to presenteeism). Employment among patients with ILD aged 25 to 54 years was 23% lower than the age-and sex-matched general Canadian population (60% vs 83%; P < .001). Employment among ABBREVIATIONS: CAD = Canadian dollar; CARE-PF = Canadian Registry for Pulmonary Fibrosis; DLCO = diffusing capacity of the lung for carbon monoxide; ILD = interstitial lung disease; IPF = idiopathic pulmonary fibrosis; VAS = visual analog scale; WPAI = work productivity and activity impairment

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Section: Discussionmentioning

confidence: 92%

Costs of Workplace Productivity Loss in Patients With Fibrotic Interstitial Lung Disease

Algamdi

Sadatsafavi

Fisher

et al. 2019

Chest

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“…More than half of the patients (53%) were considered to be uncontrolled based on ACT scores, consistent with estimates from previous studies, including estimates from primary care providers. 1,6,[11][12][13][14][15] Most patients (78.8%) classified as being not well controlled selfrated their asthma control as "at least somewhat controlled" (52.9%) or "well controlled" (25.9%), demonstrating a clear disconnect between patient self-awareness and their level of disease control. This disconnect, coupled with the high prevalence of not well-controlled asthma among those found at routine visits, and the low proportion of study sites which routinely evaluate patients for asthma control at every visit (20.7%), might suggest that routine use of the ACT or similar patient-reported outcome tools and objective measures of lung function may help to improve asthma management and disease control.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients (85%) in this study had been using an ICS/LABA in the 4 weeks previously; however, despite this, more than half were not well controlled, which is in accordance with previous studies. 1,[13][14][15] Similarly, among patients treated with low-to medium-dose ICS/LABA or medium-to high-dose ICS/LABA combination therapy, more than half (53% and 58%, respectively) were also not well controlled. Furthermore, the proportion of patients with uncontrolled asthma increased with increasing ICS dose in ICS/LABA (from approximately 46% among patients on low dose to almost 60% among those on high-dose ICS).…”

Section: Discussionmentioning

confidence: 99%

“…6,11,12 Furthermore, for patients receiving ICS/LABA therapy, the prevalence of uncontrolled asthma has been estimated at between 30% and 50%, even when treatment adherence is optimal. 1,[13][14][15] To the best of our knowledge, no previous studies have evaluated the prevalence of uncontrolled asthma in a real-world setting among patients receiving care at respiratory specialist clinics. A clearer understanding of the overall prevalence of uncontrolled asthma and associated factors in this setting may be informative in developing appropriate strategies for improving overall disease control.…”

Section: Introductionmentioning

confidence: 99%

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Real-world evidence

Oppenheimer

Slade

Hahn

et al. 2021

Annals of Allergy, Asthma & Immunology

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Background: Approximately 30% to 50% of patients with moderate/severe asthma have inadequately controlled disease despite adherence to inhaled corticosteroid (ICS)/long-acting b 2 -agonist (LABA) therapy.Data on prevalence and burden of uncontrolled asthma in specialty settings are lacking. Objective: To evaluate the prevalence and burden of uncontrolled asthma in respiratory specialist clinics in the United States. Methods: Adults with physician-diagnosed asthma attending pulmonary and allergy clinics with selfreported ICS use in the previous 4 weeks completed an electronic questionnaire including the Asthma Control Test and St George's Respiratory Questionnaire. Additional information was collected using an electronic case report form. Results: Of 774 patients attending 12 pulmonary and 12 allergy clinics, 53% were not well controlled (mean [SD] Asthma Control Test, 14.3 [3.6] vs 22.4 [1.6] in well-controlled patients). Among ICS/LABA users, 56% were not well controlled, which increased with increasing ICS dose (low-dose 45.7%; high-dose 59.7%). The not well-controlled group reported more respiratory illnesses, more comorbidities, and poorer healthrelated quality of life (mean [SD] St George's Respiratory Questionnaire, 46.1 [18.9] vs 19.8 [12.9] in the well-controlled group). These patients also had more asthma exacerbations (1 exacerbation, 68.9% vs 43.1%) and increased health care resource utilization (1 asthma-related hospitalization, 10.7% vs 2.7%); 27.3% were also receiving systemic corticosteroids. Approximately 40% of the population were eligible for step-up to ICS/LABA/long-acting muscarinic antagonist triple therapy, and 20% were eligible for biologic therapy. Conclusion: Substantial unmet needs exist among patients with inadequately controlled asthma managed in United States specialist settings, which may be addressed by improved patient and physician education, better guideline implementation, and improved adherence.

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“… 15 , 26 Some studies have detailed further indirect costs and highlighted the unmet need for severe asthma patients, as evidenced by patient questionnaires, health-related quality of life, work productivity, and activity impairment. 27–29 …”

Section: Discussionmentioning

confidence: 99%

Characteristics of Treated Asthmatics Experiencing Exacerbations in a US Database: A Retrospective Cohort Study

Averell¹,

Hinds

Fairburn-Beech

et al. 2021

JAA

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Rationale The National Heart, Lung, and Blood Institute (NHLBI) recommend a stepwise approach to asthma management, with the goals of maintaining asthma control and reducing exacerbations. Although asthma treatments reduce the frequency of exacerbations, they still occur. We aimed to characterize the treated United States of America (US) adult asthma population, including those experiencing exacerbations, in terms of socio-demographics, clinical characteristics, and healthcare resource utilization (HRU). Patients and Methods A retrospective cohort of asthma patients aged ≥18 years on 01 January 2014 with ≥1 ICD-9 asthma code (493.xx) enrolled in a US healthcare claims database during 2013–2014. Patients who had ≥2 asthma medication dispensings during 2013 (baseline), including ≥1 in the 90-day period before index date, were classified according to NHLBI step. Patients with chronic obstructive pulmonary disease, cystic fibrosis, or lung cancer diagnoses were excluded. Demographics, comorbidities, clinical characteristics, and HRU were described during baseline. Exacerbations and HRU were described during 2014 (follow-up period). Results In total, 72,156 patients were included; 10,590 (14.7%) had ≥1 exacerbation during follow-up. Approximately 44% of patients were classified as NHLBI Steps 1–2, 41% as Steps 3–4, and 11% as Steps 5–6. Exacerbation frequency increased with step (Steps 1, 2, and 3: 12–14%; Steps 4, 5, and 6: 16–26%). Compared with the overall population during baseline, patients with an exacerbation had similar demographics, but differences were observed for comorbid allergic rhinitis (46.4% vs 40.1%, respectively), blood eosinophil counts ≥300 cells/μL (45.5% vs 39.6%, respectively), and asthma-related healthcare encounters (62.9% vs 52.4%, respectively). Overall, asthma-related HRU during follow-up increased with NHLBI step. Conclusion Exacerbations were observed among patients classified at each NHLBI step and were more frequent with increasing step. Exacerbations and asthma-related HRU highlight the continued unmet need in the treated US asthma population.

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Burden of asthma among patients adherent to ICS/LABA: A real-world study

Abstract: Given the substantial burden described, greater attention to asthma monitoring and management is necessary. Identification of novel treatments may be important for patients not responding to medium/high-dosage ICS/LABA treatment.

Cited by 29 publications

References 26 publications

Costs of Workplace Productivity Loss in Patients With Fibrotic Interstitial Lung Disease

Costs of Workplace Productivity Loss in Patients With Fibrotic Interstitial Lung Disease

Real-world evidence

Characteristics of Treated Asthmatics Experiencing Exacerbations in a US Database: A Retrospective Cohort Study

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