Underuse of Inhaled Steroid Therapy in Elderly Patients With Asthma

Sin, Don D.; Tu, Jack V.

doi:10.1378/chest.119.3.720

Cited by 78 publications

(11 citation statements)

References 31 publications

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“…This finding is in line with reports from elsewhere [16–20]. In addition, unavailability of ICS in the study setting was reported from both patients and care providers as one of the factors contributing for underutilization of ICS.…”

Section: Discussionsupporting

confidence: 92%

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Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

2017

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BackgroundInhaled corticosteroids (ICSs) are cornerstone therapy for persistent asthma. However, underutilization of ICSs is common and little is known about factors contributing toward this undesirable use.MethodsA cross-sectional study was conducted through interview and chart review among persistent asthmatic patients attending chest clinic of Tikur Anbessa Specialized Hospital from 1 May to 31 September 2014. A total of 131 eligible patients who attended the clinic during study period were included in the study. A multivariate logistic regression was used to examine the association between independent and dependent variables.ResultsOverall, extent of underutilization of ICSs was found to be 68%. Monthly income, comorbidity and types of ICSs products prescribed showed significant association with reported underutilization. Patients’ reported reasons for underutilization includes; unaffordability (44%), using only when symptoms exacerbate (21%), fear of side effects (10%), practitioners’ recommendation (10%) and unavailability of ICSs in the local market (7%). Physicians also stated unaffordability, fear of side effects and dependency, lack of local guideline for asthma management and unavailability of ICSs as the contributing factors.ConclusionIn this setting, extent of underutilization of ICSs was found to be high and seems the result of complex interaction of various factors. Financial problem combined with inconsistent availability of ICSs in the local market, patients’ poor knowledge of asthma and ICSs, negative attitude toward ICSs, absence of local guidelines for asthma management are found to be essential elements dictating an extent of ICSs use.Electronic supplementary materialThe online version of this article (doi:10.1186/s13104-017-2645-2) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

“…Similar finding is reported form Canadian study [16]. Increased odds of underutilization of ICS among patients with one or more comorbidity could be due to different reasons.…”

Section: Discussionsupporting

confidence: 88%

Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

2017

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“…In 10 studies, authors attempted to provide a more refined measure of need by including measures of disease stage or severity within multivariable analyses. For example, Sin and Tu examined receipt of inhaled steroid therapy in asthma patients and included measures of disease severity in their multivariable models [34]. Twenty two studies examined receipt of specific treatments or interventions, 23 studies explored receipt of care defined more broadly (e.g.…”

Section: Resultsmentioning

confidence: 99%

Identifying inequitable healthcare in older people: systematic review of current research practice

Salway

Payne

Rimmer

et al. 2017

Int J Equity Health

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BackgroundThere is growing consensus on the importance of identifying age-related inequities in the receipt of public health and healthcare interventions, but concerns regarding conceptual and methodological rigour in this area of research. Establishing age inequity in receipt requires evidence of a difference that is not an artefact of poor measurement of need or receipt; is not warranted on the grounds of patient preference or clinical safety; and is judged to be unfair.MethodA systematic, thematic literature review was undertaken with the objective of characterising recent research approaches. Studies were eligible if the population was in a country within the Organisation for Economic Co-operation and Development and analyses included an explicit focus on age-related patterns of healthcare receipt including those 60 years or older. A structured extraction template was applied. Extracted material was synthesised in thematic memos. A set of categorical codes were then defined and applied to produce summary counts across key dimensions. This process was iterative to allow reconciliation of discrepancies and ensure reliability.ResultsForty nine studies met the eligibility criteria. A wide variety of concepts, terms and methodologies were used across these studies. Thirty five studies employed multivariable techniques to produce adjusted receipt-need ratios, though few clearly articulated their rationale, indicating the need for great conceptual clarity. Eighteen studies made reference to patient preference as a relevant consideration, but just one incorporated any kind of adjustment for this factor. Twenty five studies discussed effectiveness among older adults, with fourteen raising the possibility of differential effectiveness, and one differential cost-effectiveness, by age. Just three studies made explicit reference to the ethical nature of healthcare resource allocation by age. While many authors presented suitably cautious conclusions, some appeared to over-stretch their findings concluding that observed differences were ‘inequitable’. Limitations include possible biases in the retrieved material due to inconsistent database indexing and a focus on OECD country populations and studies with English titles.ConclusionsCaution is needed among clinicians and other evidence-users in accepting claims of healthcare ‘ageism’ in some published papers. Principles for improved research practice are proposed.Electronic supplementary materialThe online version of this article (doi:10.1186/s12939-017-0605-z) contains supplementary material, which is available to authorized users.

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“…The elderly patient may have concerns about the side-effects of the medication, poor inhaler technique or insufficient inspiratory flows, and asthma management can be affected by memory impairment or economic difficulties [6, 12]. Insufficient adherence to therapy is also frequently reported and the above-mentioned problems, in addition to poor access to care, cultural specificities, or other personal characteristics may explain such reduced adherence [40, 41]. It is also possible that the elderly asthmatic is more resistant to therapy either due to a change in asthma inflammatory phenotype or airway functional changes.…”

Section: Introductionmentioning

confidence: 99%

“…As in younger patients, inhaled corticosteroids (ICS) are the mainstay of asthma treatment in the elderly, although they are insufficiently used in this population [1, 40]. If insufficient to control asthma, we should first check inhaler technique, adherence, environmental factors, smoking status and co-morbid conditions.…”

Section: Introductionmentioning

confidence: 99%

Asthma in the elderly patient

Boulet

2016

asthma res and pract

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Asthma affects a significant proportion of elderly patients, but unfortunately, it is responsible for a high asthma-related morbidity and mortality in this population. This may be related not only to the development of a more severe asthma phenotype compared to younger patients, with more marked airway obstruction and a more neutrophilic type of airway inflammation, but also to the presence of many co-morbid conditions. Furthermore, in older patients, asthma is often under-diagnosed, undertreated and poorly managed. Unfortunately, elderly patients have usually been excluded of clinical trials on asthma and there is an urgent need to perform more research on the optimal management of asthma in this population.

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Underuse of Inhaled Steroid Therapy in Elderly Patients With Asthma

Cited by 78 publications

References 31 publications

Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

Assessment of inhaled corticosteroids use and associated factors among asthmatic patients attending Tikur Anbessa Specialized Hospital, Ethiopia

Identifying inequitable healthcare in older people: systematic review of current research practice

Asthma in the elderly patient

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