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Original Research |

Has asthma medication use caught up with the evidence? A 12-year population-based study of trends

Mohsen Sadatsafavi; Hamid Tavakoli; Larry Lynd; J Mark FitzGerald
Author and Funding Information

Funding: This study was funded by an arm’s length research contract with AstraZeneca Canada, mediated through and approved by the University-Industry Liaison Office at University of British Columbia

Conflict of interest: JMF has served on advisory boards for Novartis, Pfizer, AstraZeneca, Boehringer-Ingelheim, ALK and Merck. He has also been a member of speakers’ bureaus for, AstraZeneca, Boehringer-Ingelheim, ALK and Merck. He has received research funding paid directly to the University of British Columbia from the AstraZeneca, Glaxo-SmithKline, Boehringer-Ingelheim, Merck, Sanofi, Amgen, and Genentech. Dr. FitzGerald is a member of the Global Initiative for Asthma (GINA) Executive and Science Committees. Dr. Sadatsafavi receives salary support from the Canadian Institutes of Health Research and Michael Smith Foundation for Health Research.

Author contribution: MS, JMF, and LL formulated the idea. MS and HT designed the study and created the data analysis plan. JMF and LL provided feedback on the design. HT performed all the statistical analyses. MS wrote the first draft of the manuscript. All authors critically commented on the manuscript and approved the final version. MS and HT are guarantors of the manuscript.

1Collaboration for Outcomes Research and Evaluation, Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada

2Institute for Heart and Lung Health, Department of Medicine, the University of British Columbia, Vancouver, Canada

3Centre for Clinical Epidemiology and Evaluation, the University of British Columbia, Vancouver, Canada

4Centre for Health Evaluation and Outcomes Research, University of British Columbia, Vancouver, Canada

Corresponding author: Mohsen Sadatsafavi Centre for Clinical Epidemiology and Evaluation 7th Floor, 828 West 10th Avenue Research Pavilion Vancouver, BC V5Z 1M9.


Copyright 2016, . All Rights Reserved.


Chest. 2016. doi:10.1016/j.chest.2016.10.028
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Abstract

Background  The importance of balance between controller and reliever medications in asthma is recognized. However, to what extent real-world practice has caught up with evidence-based guidelines is not studied.

Methods  This was a retrospective cohort study of individuals 15 to 67 years old who satisfied a validated case definition of asthma in the administrative health data of British Columbia, Canada, between 2002 and 2013. Each patient-year was assessed for inappropriate and excessive prescription of SABAs and the balance between controller and reliever medications. Trends on three time axes were evaluated: calendar time, time course of asthma, and age. Poisson regression was used to test for linear trend.

Findings  356,112 patients (56.5% female, mean age 30.5) contributed 2.6M patient-years. In 7.3% of patient-years, SABAs were prescribed inappropriately. This proportion dropped by a relative rate of 5.3%/year (P<0.001). In the first year of asthma, 6.3% of patients had indicators of inappropriate SABA use, which dropped within the first three years but increased thereafter. Excessive prescription of SABAs increased rapidly during the time course of asthma (change of 23.3%/year, P<0.001) and by age (change of 5.1%/year, P<0.001).

Conclusions  Despite overwhelming evidence on risks, inappropriate prescription for SABAs was prevalent. Excessive SABA use might explain high asthma mortality in older patients. Inappropriate prescriptions declined over the study period but increased over the time course of asthma. These trends might have contributed to the declining asthma hospitalization rates in British Columbia, but there remain gaps in care and potentials for improvement in asthma outcomes.


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