Trends and predictors of specialist assessments in oral corticosteroid treated asthma among young adults

Abstract

BackgroundRepeated oral corticosteroid use indicates uncontrolled disease among asthma patients and referral for asthma specialist assessment is recommended. We aimed to describe trends and predictors associated with specialist contacts among young adults with asthma and repeated oral corticosteroid use.MethodsIndividuals aged 18–45 years with ≥2 dispensed asthma medication prescriptions and two dispended oral corticosteroid prescriptions (including short-term and long-term treatments) within 12 months during 1999–2018 were identified by use of Danish healthcare registers. The frequency of specialist contacts within 1 year of follow-up was assessed among individuals without previous specialist contacts within 5 years of inclusion. Factors associated with specialist contact were identified by logistic regression models. Furthermore, oral corticosteroid prescriber sources were assessed.ResultsFor the 11 223 individuals included, 2444 (22%) had previous specialist contacts care within 5 years prior of inclusion and additionally 926 (8.3%) within 1 year of follow-up. Among those without previous specialist contacts (n 8779), the frequency of incident specialist contacts within 1 year of follow-up increased from 6.3% in 1999 to 18% in 2017. Factors associated with incident specialist contacts included dispensing ≥12 SABA canisters and previous asthma-related emergency department visits and hospitalisations. The majority of oral corticosteroid prescriptions at baseline (71%) were prescribed by general practitioners, though with decreasing proportions from 1999–2018.ConclusionsThe majority (70%) of young adults with asthma and repeated oral corticosteroid use do not seem to receive specialist assessment in Denmark. This highlights a potential room for improvement in the patient referral pathway for at-risk asthma patients.

Proactive Risk Management: A Novel Approach to Embedding Oral Corticosteroid Stewardship into Asthma Care

“…In summary, long-term OCS use remains highly prevalent in patients with severe asthma, [15][16][17] while relatively few patients with asthma are referred to a specialist. [18][19][20] This is despite the evidence to show that referral for assessment by a specialist may actually reduce OCS use and improve outcomes. [18][19][20] The continued dependence on OCS therapy in severe asthma persists despite clear evidence to show that even intermittent use of OCS is associated with AEs.…”

“…[18][19][20] This is despite the evidence to show that referral for assessment by a specialist may actually reduce OCS use and improve outcomes. [18][19][20] The continued dependence on OCS therapy in severe asthma persists despite clear evidence to show that even intermittent use of OCS is associated with AEs. [24][25][26][27] Furthermore, comorbidities are common in severe asthma, and also contribute to higher OCS use and exacerbation rates, while the risk of comorbidities themselves also increases with frequency of OCS use.…”

“…16 Similar data are reported in the UK, with the Severe Asthma Registry of 2,225 patients with severe asthma showing that 51.7% were receiving long-term OCS at a median dose of 10.0 mg/day. 17 Further studies from the UK, USA, and Denmark report that only a small proportion of patients with severe asthma are referred to a specialist, [18][19][20] despite such a referral resulting in a change of treatment in 55 -68% of patients in one study. 19 Referral rates are particularly low in the USA, where only 8% of patients with asthma managed in primary care were referred to a specialist within 24 months of treatment, despite 43% having uncontrolled asthma.…”