0
Original Research: Obstructive Lung Diseases |

Long-term Outcomes After Stepping Down Asthma Controller MedicationsOutcomes After Stepping Down Asthma Medications: A Claims-Based, Time-to-Event Analysis

Matthew A. Rank, MD; Ryan Johnson, MBA, MS; Megan Branda, MS; Jeph Herrin, PhD; Holly van Houten, BS; Michael R. Gionfriddo, PharmD; Nilay D. Shah, PhD
Author and Funding Information

From the Division of Allergy, Asthma, and Clinical Immunology (Dr Rank), Mayo Clinic, Scottsdale, AZ; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery (Drs Rank and Shah, Mr Johnson, and Ms van Houten), Division of Health Care Policy and Research (Ms Branda and Drs Gionfriddo and Shah), and Knowledge Encounter Unit (Ms Branda), Mayo Clinic, Rochester, MN; Division of Cardiology (Dr Herrin), Yale University, New Haven, CT; Health Research & Educational Trust (Dr Herrin), Chicago, IL; and Optum Labs (Dr Shah), Optum, Inc, Cambridge, MA.

CORRESPONDENCE TO: Matthew A. Rank, MD, Division of Allergy, Asthma, and Clinical Immunology, Mayo Clinic, 13400 E Shea Blvd, Scottsdale, AZ 85255; e-mail: rank.matthew@mayo.edu


Part of this article has been presented in poster form at the AcademyHealth Annual Meeting, June 9, 2014, San Diego, CA.

FUNDING/SUPPORT: The funding for this study came from the Mayo Foundation for Medical Education and Research and with support of resources from the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. Dr Gionfriddo was supported by a Clinical and Translational Science Award [Grant TL1 TR000137] from the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health.

Reproduction of this article is prohibited without written permission from the American College of Chest Physicians. See online for more details.


Chest. 2015;148(3):630-639. doi:10.1378/chest.15-0301
Text Size: A A A
Published online

BACKGROUND:  Long-term outcomes after stepping down asthma medications are not well described.

METHODS:  This study was a retrospective time-to-event analysis of individuals diagnosed with asthma who stepped down their asthma controller medications using a US claims database spanning 2000 to 2012. Four-month intervals were established and a step-down event was defined by a ≥ 50% decrease in days-supplied of controller medications from one interval to the next; this definition is inclusive of step-down that occurred without health-care provider guidance or as a consequence of a medication adherence lapse. Asthma stability in the period prior to step-down was defined by not having an asthma exacerbation (inpatient visit, ED visit, or dispensing of a systemic corticosteroid linked to an asthma visit) and having fewer than two rescue inhaler claims in a 4-month period. The primary outcome in the period following step-down was time-to-first asthma exacerbation.

RESULTS:  Thirty-two percent of the 26,292 included individuals had an asthma exacerbation in the 24-month period following step-down of asthma controller medication, though only 7% had an ED visit or hospitalization for asthma. The length of asthma stability prior to stepping down asthma medication was strongly associated with the risk of an asthma exacerbation in the subsequent 24-month period: < 4 months’ stability, 44%; 4 to 7 months, 34%; 8 to 11 months, 30%; and ≥ 12 months, 21% (P < .001).

CONCLUSIONS:  In a large, claims-based, real-world study setting, 32% of individuals have an asthma exacerbation in the 2 years following a step-down event.

Figures in this Article

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Topics

asthma

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Figures

Tables

References

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Some tools below are only available to our subscribers or users with an online account.

Sign In to Access Full Content

MEMBER & INDIVIDUAL SUBSCRIBER

Want Access?

NEW TO CHEST?

Become a CHEST member and receive a FREE subscription as a benefit of membership.

Individuals can purchase this article on ScienceDirect.

Individuals can purchase a subscription to the journal.

Individuals can purchase a subscription to the journal or buy individual articles.

Learn more about membership or Purchase a Full Subscription.

INSTITUTIONAL ACCESS

Institutional access is now available through ScienceDirect and can be purchased at myelsevier.com.

Related Content

Customize your page view by dragging & repositioning the boxes below.

Find Similar Articles
CHEST Journal Articles
PubMed Articles
  • CHEST Journal
    Print ISSN: 0012-3692
    Online ISSN: 1931-3543