The burden of adult asthma in Finland: impact of disease severity and eosinophil count on health care resource utilization

Viinanen, Arja; Lassenius, Mariann I.; Toppila, Iiro; Karlsson, Antti; Veijalainen, Lauri; Idänpään-Heikkilä, J; Laitinen, Tarja

doi:10.1080/02770903.2019.1633664

Cited by 12 publications

(13 citation statements)

References 28 publications

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“…The main goal in the management of patients with severe asthma is achieving disease control and reducing risk of attacks while avoiding harm from controller therapies 1,2 . Despite extensive efforts, there is still a small proportion of patients with severe asthma insufficiently controlled with the current medications, with a significant burden due to high morbidity and costs 3‐8 . Current guidelines support the targeted approach in uncontrolled severe asthma, and several biologicals are approved for use in these patients 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…1,2 Despite extensive efforts, there is still a small proportion of patients with severe asthma insufficiently controlled with the current medications, with a significant burden due to high morbidity and costs. [3][4][5][6][7][8] Current guidelines support the targeted approach in uncontrolled severe asthma, and several biologicals are approved for use in these patients. 1,2 [Correction added on 05 October 2021, after first online publication.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines—Recommendations on the use of biologicals in severe asthma

Agache

Song

Rocha

et al. 2020

Allergy

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Dupilumab, a fully human monoclonal antibody against interleukin-4 receptor α, is approved as add-on maintenance treatment for inadequately controlled type 2 severe asthma. This systematic review evaluated the efficacy, safety and economic impact of dupilumab compared to standard of care for uncontrolled severe asthma. PubMed, EMBASE and Cochrane Library were searched for RCTs and health economic evaluations.Critical and important asthma-related outcomes were evaluated. The risk of bias and the certainty of the evidence were assessed using GRADE. Three RCTs including 2735 subjects >12 years old and 24-52 weeks of follow-up were included. Dupilumab reduced with high certainty severe asthma exacerbations (Incidence rate ratio 0.51; 95% CI 0.45-0.59) and the percentage use of oral corticosteroid use (mean difference (MD) −28.2 mg/d; 95% CI −40.7 to −15.7). Asthma control (ACQ-5), quality of life (AQLQ) and rescue medication use [puffs/d] improved, without reaching the minimal important clinical difference: ACQ-5 MD −0.28 (95% CI −0.39 to −0.17); AQLQ MD +0.28 (95% CI 0.20-0.37); and rescue medication MD −0.35 (95% CI −0.73 to +0.02). FEV 1 increased (MD +0.15; 95% CI +0.11 to +0.18) (moderate certainty). There was an increased rate of dupilumab-related adverse events (AEs) (moderate certainty) and of drug-related serious AEs (low certainty). The incremental cost-effectiveness ratio of dupilumab versus standard therapy was 464 000$/ QALY (moderate certainty). More data on long-term safety are needed both for children and for adults, together with more efficacy data in the paediatric population.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines—Recommendations on the use of biologicals in severe asthma

Agache

Song

Rocha

et al. 2020

Allergy

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“…High blood eosinophil counts in patients with asthma have been shown to correlate with an increased mortality risk (26). Furthermore, blood eosinophilia in COPD with asthma-like features is associated with an improved survival (27)(28)(29). This suggests that the prognosis is better in patients with asthma and COPD with blood eosinophilia receiving appropriate treatment than in those receiving inappropriate treatment and that its estimation is important for…”

Section: D．mortalitymentioning

confidence: 99%

Measurement of Blood Eosinophils in Asthma and Chronic Obstructive Pulmonary Disease

Hirano

Matsunaga

2023

Intern. Med.

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Eosinophils are important effector cells in airway inflammation, as pleiotropy and heterogeneity can be linked to various pathophysiologies in asthma and chronic obstructive pulmonary disease (COPD). Sputum eosinophils can reflect the heterogeneity of airway inflammation, and owing to their traits, blood eosinophils can be a surrogate and potential biomarker for managing both conditions. Blood eosinophils are activated via the stimulation of type 2 cytokines, such as interleukin (IL)-5, IL-4/13, granulocyte-macrophage colonystimulating factor, IL-33, and thymic stromal lymphopoietin. There is sufficient evidence to support the relationship between the blood eosinophil count and clinical outcomes, including pulmonary function decline, exacerbations, all-cause mortality, and treatment response to inhaled corticosteroids and biologics. Thus, there is growing interest in the use of blood eosinophils for the management of these diseases. Compiling recent evidence, we herein review the significance of measuring blood eosinophils in asthma and COPD.

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“…In Nordic countries, recent estimates suggest asthma prevalence ranges from 5.2% (Denmark) to 11.2% (Finland) [ 10 , 11 ], while greater variation exists in reported prevalence rates of severe and uncontrolled asthma. For example, in Sweden, approximately 4.2% of the patients with asthma have severe disease, more than half of whom (53.6%) have poorly controlled asthma [ 12 ]; by comparison, an estimated 8.6% of the Finnish patients with asthma have severe disease, nearly half of which (46.6%) are likely uncontrolled [ 13 ]. Of the estimated 8.1% of the patients with asthma in Denmark who have severe disease, 36.4% have been reported to have poor asthma control [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

“…As a result, in 2019 GINA amended its guidelines to recommend that health care providers consider side-effects before prescribing OCS. Recent data from Nordic countries suggest that nearly 25% of the Swedish patients with asthma and 47% of the Finnish patients with severe asthma use OCS [ 13 , 23 ]. Effective alternatives to OCS, to achieve and maintain asthma control, have emerged in the past 20 years, including the development of biologic therapies like monoclonal antibodies against inflammatory mediators or interleukin receptors.…”

Section: Introductionmentioning

confidence: 99%

Regional variation in intensity of inhaled asthma medication and oral corticosteroid use in Denmark, Finland, and Sweden

Lehtimäki

Arvidsson

Erdemli³

et al. 2022

European Clinical Respiratory Journal

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Oral corticosteroids (OCS) are often prescribed to patients with asthma that remains uncontrolled with maintenance therapy. We performed a real-world analysis to describe the geographic distributions of patients with asthma and OCS dispensed in Nordic countries. This observational, retrospective study examined patient-level data from nationally prescribed drug registries from January to December 2018 for individuals aged ≥12 years in Denmark, Finland, and Sweden. Using an algorithm based on asthma treatment combinations defined by the Global Initiative for Asthma (GINA), we identified patients with asthma, those on GINA Step 4–5 treatments, and those being dispensed ≥2 courses of OCS and determined volumes of OCS dispensed to these patients over the 1-year analysis period. Data were plotted geographically within each country using colour-coded heat maps. The overall asthma prevalence rates were 7.4% in Denmark, 11.6% in Finland, and 8.1% in Sweden. In Denmark, Finland, and Sweden, respectively, the frequencies of patients on GINA Step 4–5 treatments were 19%, 15%, and 16%; among whom 10%, 23%, and 5% received ≥2 courses of OCS. The rates of patients on GINA Step 4–5 treatments who were dispensed OCS in each country were 23%, 30%, and 46%, of which 22%, 17%, and 10% were dispensed doses averaging ≥5 mg/day over the year. Heat maps revealed considerable heterogeneity in geographic densities of patients with asthma and OCS claims within each country. Taken together, these results demonstrate regional variations in estimated asthma severity, control, and OCS dispensed within and between countries. Patterns of medication use suggest that a high proportion of patients in Denmark, Finland, and Sweden are on GINA Step 4–5 treatments, many of whom are dispensed OCS; this poses a considerable corticosteroid burden to these patients. Geographic differences in medication use within and between Nordic countries may reflect variations in population characteristics and/or treatment approaches.

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The burden of adult asthma in Finland: impact of disease severity and eosinophil count on health care resource utilization

Cited by 12 publications

References 28 publications

Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines—Recommendations on the use of biologicals in severe asthma

Efficacy and safety of treatment with dupilumab for severe asthma: A systematic review of the EAACI guidelines—Recommendations on the use of biologicals in severe asthma

Measurement of Blood Eosinophils in Asthma and Chronic Obstructive Pulmonary Disease

Regional variation in intensity of inhaled asthma medication and oral corticosteroid use in Denmark, Finland, and Sweden

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