Recent changes in persistent asthma care
Published online: March 2, 2019
At the time of arrival of biotherapies, it is important to document ongoing asthma care and outcomes, and recent changes. In the original research published by Belhassen and colleagues in The Journal of Allergy and Clinical Immunology: in Practice, the authors investigated national claims data to describe asthma care between 2006 and 2016 in France, regarding the use of controller therapies, healthcare resource utilization, and asthma outcomes rates.
The authors utilized the 1% random sample of national claims data (universal health care system covering the full population) to conduct annual transversal analyses between 2006 and 2016. Analyses were performed on two contrasted populations: a sensitive and a specific population. The sensitive population consisted of patients aged 18-40 years identified each calendar year from ≥1 dispensing of controller therapy. The specific population consisted of patients aged 18-40 years with ≥4 annual dispensings of controller therapy. Clinical and demographic features were described, and comparisons were made between 2006 and 2016 to assess temporal changes in asthma therapy, healthcare resource utilization, and outcomes.
Changes in persistent asthma care included replacement of inhaled corticosteroids by fixed-dose combinations, decreased use of long-acting β-agonists as a monotherapy, decreased involvement of General Practitioners, and increased involvement of secondary care physicians. In parallel, despite low figures for hospital admissions and mortality, overall use of oral corticosteroids, and incidence of emergency room visits increased over this decade.
The current data suggest inappropriate implementation of asthma management guidelines. Improvements of care are awaited, including increased support for self-management training.
The Journal of Allergy and Clinical Immunology: In Practice is an official journal of the AAAAI, focusing on practical information for the practicing clinician.