Inhaled corticosteroids and asthma control in adult-onset asthma: 12-year follow-up study

Respir Med. 2018 Apr;137:70-76. doi: 10.1016/j.rmed.2018.02.025. Epub 2018 Mar 2.

Abstract

Background: Prescribed inhaled corticosteroid (ICS) doses in asthma have been studied in cross-sectional settings whereas long-term follow-up studies have not been carried out.

Objective: To evaluate prescribed medication longitudinally by calculating cumulative ICS doses and dose changes in a cohort of new-onset adult asthma during 12 years and in different groups of asthma control.

Methods: A total of 203 patients were followed for 12 years as part of Seinäjoki Adult Asthma Study (SAAS). All asthma-related visits and prescribed medication over the study period were collected from medical records.

Results: Total cumulative ICS dose for the 12-year follow-up period was 3.4g (±SEM 0.1) per patient. Both respiratory specialists and GPs prescribed step-ups and step-downs in ICS treatment and in total 649 dose changes were noted during the follow-up (median 3(1-5) per patient). Patients with uncontrolled asthma received higher ICS doses throughout the follow-up period, and therefore, cumulative 12-year ICS dose (3.8g ± SEM 0.2) in this group was higher than that in those with partially controlled (3.4g ± SEM 0.2) or controlled disease (2.9g ± SEM 0.2) (p = 0.0001). Patients with uncontrolled asthma were also prescribed a higher number of ICS dose changes than patients with controlled disease.

Conclusion: Despite frequent dose changes and high ICS doses during the 12-year follow-up, the level of asthma control remained poor in patients with uncontrolled asthma. This suggests that high ICS doses may not be effective enough for management of disease in patients with uncontrolled adult-onset asthma and novel targeted treatments are required.

Trial registration: ClinicalTrials.gov NCT02733016.

Keywords: Adult; Asthma; Asthma-control; Cumulative dose; Inhaled corticosteroids; Prescription.

Publication types

  • Clinical Trial
  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Administration, Inhalation
  • Adrenal Cortex Hormones / administration & dosage
  • Adrenal Cortex Hormones / therapeutic use*
  • Adult
  • Anti-Asthmatic Agents / administration & dosage
  • Anti-Asthmatic Agents / therapeutic use*
  • Asthma / diagnosis
  • Asthma / drug therapy*
  • Budesonide / administration & dosage
  • Budesonide / therapeutic use*
  • Cross-Sectional Studies
  • Dose-Response Relationship, Drug
  • Female
  • Finland / epidemiology
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Prospective Studies

Substances

  • Adrenal Cortex Hormones
  • Anti-Asthmatic Agents
  • Budesonide

Associated data

  • ClinicalTrials.gov/NCT02733016