Published online: February 10, 2017
Chronic oral corticosteroid (C-OCS) use in asthma is an indicator of disease severity, but factors associated with C-OCS use in adults with persistent asthma need to be identified. Zeiger and colleagues, in a recent issue of the The Journal of Allergy and Clinical Immunology: In Practice determined the patient characteristics and disease burden associated with C-OCS use among 9,546 patients aged 18 to 64 years with persistent asthma enrolled in a large managed care organization. The study calculated cumulative OCS dispensed per patient in 2010 and examined the distribution of disease characteristics by average daily amounts of OCS dispensed. C-OCS use was defined as 2.5 mg/day or more. Baseline factors (2010) associated with C-OCS use during follow-up (2011) were investigated by multivariable regression analyses.
Of the cohort, 782 (8.2%) patients were C-OCS users. C-OCS users were significantly older and more often female and ethnic minorities. In addition, C-OCS users had significantly more asthma specialist care, greater asthma step-care level, controllers, asthma exacerbations, and higher blood eosinophil count. C-OCS users experienced more asthma-related comorbidities (obesity, gastroesophageal reflux, pneumonia, rhinitis, chronic sinusitis, eczema, and nasal polyp disease) and corticosteroid-related comorbidities (cataract, osteoporosis, fractures, hypertension, infections, anxiety, and ulcer disease).
Baseline factors significantly associated with C-OCS use in the follow-up year included (1) demographic characteristics: older age, females, and blacks versus whites; (2) disease burden: more asthma emergency department or hospitalization visits, greater asthma step-care level, excessive short-acting β2-agonist dispensed, theophylline use, asthma specialist care, and nasal polyposis; (3) higher blood eosinophil counts; and (4) most strongly, prior C-OCS use.
C-OCS use was the major independent predictor of future C-OCS use. The study’s findings strongly support real-time identification of C-OCS users, which should prompt physicians to implement more aggressive asthma management to reduce C-OCS use.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.