Department of Pulmonary, Critical Care, and Sleep Medicine, Yale University, New Haven, Connecticut.
Boys Town National Research Hospital, Boys Town, Nebraska.
Ann Allergy Asthma Immunol. 2024 Sep;133(3):302-309. doi: 10.1016/j.anai.2024.05.003. Epub 2024 May 11.
Asthma control assessment is based on impairment (current symptoms) and risk (exacerbation history).
To understand the extent of uncontrolled asthma, we assessed relationships between prescription fills for systemic corticosteroids (SCS) and short-acting β-agonists (SABA) as risk and impairment markers, respectively.
Annual SCS and SABA fills among US patients with asthma were evaluated by a retrospective analysis of the IQVIA Longitudinal Access and Adjudication Data. Patients' disease severity was assigned based on the Global Initiative for Asthma step-therapy level. Exacerbations were evaluated by SCS fills within 12 months of a first asthma prescription fill. Uncontrolled asthma was defined as 2 or more SCS and/or 3 or more SABA fills annually. Individual patient relationships between SCS and SABA fills were assessed using Pearson's correlation coefficients.
A total of 4,506,527 patients were included; 15.1% had 2 or more SCS fills, 29.1% had 3 or more SABA fills, and 37.4% fulfilled either or both criteria. If only SCS use was assessed, 21.4% of cases that were treated as mild to moderate and 27.6% that were treated as severe asthma would have been misclassified as controlled. If only SABA use was evaluated, 7.8% of cases treated as mild to moderate and 11.2% treated as severe asthma would have been misclassified. Overall, 80.9% of uncontrolled asthma occurred in patients treated for mild to moderate disease. Among patients with 2 or more SCS fills, the mean SABA fills were 2.9; the correlation between SCS and SABA fills per patient was significant but weak (r = 0.18; P < .001).
High symptom burden and SCS exposures are not limited to severe asthma but are also characteristic of patients treated for mild to moderate disease. Both impairment and risk assessments are required to understand the full extent of uncontrolled asthma across disease severities.
哮喘控制评估基于损害（当前症状）和风险（加重史）。
为了了解未控制哮喘的程度，我们评估了处方中全身皮质类固醇（SCS）和短效β-激动剂（SABA）的使用情况，分别作为风险和损害标志物。
通过对 IQVIA 纵向获取和裁决数据的回顾性分析，评估了美国哮喘患者的年度 SCS 和 SABA 用药情况。根据全球哮喘倡议的阶梯治疗水平，对患者的疾病严重程度进行了分类。通过 SCS 在首次哮喘处方后 12 个月内的使用情况评估加重情况。将每年使用 2 次或以上 SCS 和/或 3 次或以上 SABA 定义为未控制哮喘。使用 Pearson 相关系数评估单个患者 SCS 和 SABA 使用之间的关系。
共纳入 4506527 例患者；15.1%有 2 次或以上 SCS 用药，29.1%有 3 次或以上 SABA 用药，37.4%符合其中一项或两项标准。如果仅评估 SCS 的使用情况，21.4%被诊断为轻度至中度哮喘和 27.6%被诊断为重度哮喘的患者将被错误地归类为控制良好。如果仅评估 SABA 的使用情况，7.8%被诊断为轻度至中度哮喘和 11.2%被诊断为重度哮喘的患者将被错误地归类。总的来说，80.9%的未控制哮喘发生在轻度至中度疾病的患者中。在有 2 次或以上 SCS 用药的患者中，SABA 的平均用药次数为 2.9；每位患者 SCS 和 SABA 用药之间的相关性虽显著但较弱（r = 0.18；P <.001）。
高症状负担和 SCS 暴露不仅限于重度哮喘，也存在于轻度至中度疾病的患者中。为了全面了解不同严重程度的未控制哮喘，需要同时进行损害和风险评估。
