High oral corticosteroid use by asthma patients in the United States
Published online: June 19, 2020
Oral corticosteroids (OCS) are being used often in the treatment of asthma. Treatment guidelines recommend limiting their use to adult patients with severe persistent asthma and poorly controlled symptoms, or for patients experiencing exacerbations (asthma attacks) while receiving controller medications. OCS can lead to significant adverse effects, such as osteoporosis, fractures, gastrointestinal issues, visual disturbances, and metabolic syndrome. Despite these risks, little is known about OCS prescribing patterns for patients with asthma.
In a recent study published in The Journal of Allergy and Clinical Immunology: In Practice, Tran and colleagues sought to better understand OCS use for asthma in the United States. They analyzed patterns of OCS prescriptions data from US medical claims databases from January 1, 2012, through December 31, 2017. Patients identified were ages 12 years and up with persistent asthma. Medical claim records covered the 6 months leading up to confirmation of persistent asthma and 24 months of subsequent follow-up for inclusion in the study. OCS treatment was determined based on drug names and oral routes of administration indicated in prescription claims records. High OCS use was defined as having received ≥450 mg OCS prescribed within a 90-day period (i.e., average daily dosage ≥5 mg).
Of nearly 440,000 eligible patients, 65% received OCS at least once, and 19% (nearly 84,000 patients) were classified as high OCS users at some point during follow up. During the entire follow-up period, the average dosage for high OCS users was 2.2 mg per day vs. 0.3 mg per day for low OCS users. Once established as high OCS users, patients had average daily dosages between 5.l mg to 7.1 mg per day that remained stable for up to 3 years. A substantial percentage of patients with mild to moderate asthma at baseline also received OCS during the follow-up period and many of these patients eventually became high OCS users. Together, these results reveal that patients with persistent asthma in the United States have had high exposure to OCS, which may put them at substantial risk for OCS-related adverse effects.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.