Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies

Mariana Romão; Carolina Bulhosa; Zilda Mendes; Catarina Sousa; Graça Silva; Mariana Pereira; Filipa Bernardo; António Teixeira Rodrigues; João A Fonseca; Jaime Correia de Sousa

doi:10.2147/JAA.S377896

Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies

J Asthma Allergy. 2022 Nov 9:15:1579-1592. doi: 10.2147/JAA.S377896. eCollection 2022.

Authors

Affiliations

¹ Centre for Health Evaluation & Research/Infosaude (CEFAR/IS), National Association of Pharmacies (ANF), Lisbon, Portugal.
² Medical Department, AstraZeneca, Barcarena, Portugal.
³ MEDIDA - Medicina, Educação, Investigação, Desenvolvimento e Avaliação, Porto, Portugal.
⁴ Life and Health Sciences Research Institute (ICVS), PT Government Associate Laboratory, School of Medicine, University of Minho, Braga, Portugal.
⁵ Center for Health Technology and Services Research (CINTESIS), Faculty of Medicine, University of Porto, Porto, Portugal.
⁶ CUF Allergy Unit, Porto Hospital and Institute, Porto, Portugal.

Abstract

Purpose: Oral corticosteroids (OCS) are frequently used in asthma management but have an important risk-profile. The aim of the study is to characterize and compare the sociodemographic and clinical characteristics, treatment regimen and asthma control between OCS users and non-users among the population of asthma patients (≥18 years) at GINA step 3 and above treated with a fixed combination of an inhaled corticosteroid and a long-acting beta-agonist (ICS/LABA).

Methods: Cross-sectional study in Portuguese community pharmacies. Data was collected via paper-based interview delivered at the pharmacy (sociodemographic characteristics and asthma treatment regimen, namely ICS/LABA and OCS utilization), followed by a telephonic interview collecting smoking history, comorbidities, body mass index (BMI), history of exacerbations and asthma-related healthcare resource utilization (HCRU) in the previous 12 months, as well as asthma control using the Control of Allergic Rhinitis and Asthma Test (CARAT®).

Results: A total of 347 patients recruited in 98 pharmacies were included in the analysis. Of those, 328 had completed both questionnaires. A quarter of the individuals reported OCS use in the previous 12 months (OCS users), either as add-on therapy (6%) or exacerbation treatment (19%). Patients were mostly females (72%), with an average age of 59.5 years (SD=15.4). OCS users were significantly older and reported more frequently having conjunctivitis (25.9% vs 15.0%), osteoporosis (25.9% vs 13.4%), arthritis (14.6% vs 6.9%), and gastrointestinal disease (16.1% vs 8.1%). OCS users also reported greater urgent HCRU: unscheduled consultations (33.3% vs 9.3%) and emergency department (ED) visits (32.1% vs 12.1%). Both groups presented poor disease control (85.2% of OCS users vs 72.9% of non-OCS users).

Conclusion: These results highlight the burden of OCS therapy to asthma patients and the need to improve asthma management, by adopting OCS sparing strategies in this subgroup of patients.

Keywords: CARAT; COVID-19; ICS/LABA; asthma; asthma control; oral corticosteroids.

Grants and funding

This study was sponsored and funded by AstraZeneca, Portugal.