Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
권호 표지
DOI QR코드

DOI QR Code

Recent 10 Years' Trend Analysis of Inhaled Corticosteroids Prescription Rate and Severe Exacerbation Rate in Asthma Patients

최근 10년간 천식환자에서 흡입 스테로이드제 처방 빈도와 중증 악화 빈도의 추세 분석

  • Noh, Chang-Suk (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae-Seung (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Jin-Woo (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Tae-Bum (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Nam-Kug (Department of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Cho, You-Sook (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Do (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Moon, Hee-Bom (Department of Allergy and Clinical Immunology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Oh, Yeon-Mok (Department of Pulmonary and Critical Care Medicine, Asan Medical Center, University of Ulsan College of Medicine)
  • 노창석 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 이재승 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 송진우 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 김태범 (울산대학교 의과대학 서울아산병원 알레르기내과학교실) ;
  • 김남국 (울산대학교 의과대학 서울아산병원 영상의학교실) ;
  • 조유숙 (울산대학교 의과대학 서울아산병원 알레르기내과학교실) ;
  • 이상도 (울산대학교 의과대학 서울아산병원 호흡기내과학교실) ;
  • 문희범 (울산대학교 의과대학 서울아산병원 알레르기내과학교실) ;
  • 오연목 (울산대학교 의과대학 서울아산병원 호흡기내과학교실)
  • Received : 2011.02.05
  • Accepted : 2011.04.10
  • Published : 2011.05.30
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Inhaled corticosteroids (ICSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting. Methods: We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years. Results: The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively. Conclusion: The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.

Keywords

References

  1. Global Initiative for Asthma (GINA). Global strategy for asthma management and prevention, updated 2010 [Internet]. Capetown, South Africa: GINA; c2010 [cited 2011 May 13]. Available from: http://www.ginasthma.org/download.asp?intId=430.
  2. Barnes PJ. How corticosteroids control inflammation: Quintiles Prize Lecture 2005. Br J Pharmacol 2006;48:245-54.
  3. Juniper EF, Kline PA, Vanzieleghem MA, Ramsdale EH, O'Byrne PM, Hargreave FE. Effect of long-term treatment with an inhaled corticosteroid (budesonide) on airway hyperresponsiveness and clinical asthma in nonsteroid-dependent asthmatics. Am Rev Respir Dis 1990;142:832-6. https://doi.org/10.1164/ajrccm/142.4.832
  4. Haahtela T, Jarvinen M, Kava T, Kiviranta K, Koskinen S, Lehtonen K, et al. Comparison of a beta 2-agonist, terbutaline, with an inhaled corticosteroid, budesonide, in newly detected asthma. N Engl J Med 1991;25:388-92.
  5. van Essen-Zandvliet EE, Hughes MD, Waalkens HJ, Duiverman EJ, Pocock SJ, Kerrebijn KF. Effects of 22 months of treatment with inhaled corticosteroids and/or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. The Dutch Chronic Non-specific Lung Disease Study Group. Am Rev Respir Dis 1992;146:547-54. https://doi.org/10.1164/ajrccm/146.3.547
  6. Pauwels RA, Lofdahl CG, Postma DS, Tattersfield AE, O'Byrne P, Barnes PJ, et al. Effect of inhaled formoterol and budesonide on exacerbations of asthma. Formoterol and Corticosteroids Establishing Therapy (FACET) International Study Group. N Engl J Med 1997;337:1405-11. https://doi.org/10.1056/NEJM199711133372001
  7. Ernst P, Spitzer WO, Suissa S, Cockcroft D, Habbick B, Horwitz RI, et al. Risk of fatal and near-fatal asthma in relation to inhaled corticosteroid use. JAMA 1992;68:3462-4.
  8. Donahue JG, Weiss ST, Livingston JM, Goetsch MA, Greineder DK, Platt R. Inhaled steroids and the risk of hospitalization for asthma. JAMA 1997;277:887-91. https://doi.org/10.1001/jama.1997.03540350037030
  9. Barnes PJ. Current issues for establishing inhaled corticosteroids as the antiinflammatory agents of choice in asthma. J Allergy Clin Immunol 1998;101:427-33. https://doi.org/10.1016/S0091-6749(98)70261-1
  10. Blais L, Suissa S, Boivin JF, Ernst P. First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma. Thorax 1998;53:1025-9. https://doi.org/10.1136/thx.53.12.1025
  11. Blais L, Ernst P, Boivin JF, Suissa S. Inhaled corticosteroids and the prevention of readmission to hospital for asthma. Am J Respir Crit Care Med 1998;158:126-32. https://doi.org/10.1164/ajrccm.158.1.9707107
  12. Suissa S, Ernst P, Benayoun S, Baltzan M, Cai B. Low-dose inhaled corticosteroids and the prevention of death from asthma. N Engl J Med 2000;343:332-6. https://doi.org/10.1056/NEJM200008033430504
  13. Davidsen JR, Søndergaard J, Hallas J, Siersted HC, Lykkegaard J, Andersen M. Increased use of inhaled corticosteroids among young Danish adult asthmatics: an observational study. Respir Med 2010;104:1817-24. https://doi.org/10.1016/j.rmed.2010.06.002
  14. Rabe KF, Vermeire PA, Soriano JB, Maier WC. Clinical management of asthma in 1999: the Asthma Insights and Reality in Europe (AIRE) study. Eur Respir J 2000;16:802-7. https://doi.org/10.1183/09031936.00.16580200
  15. Partridge MR, van der Molen T, Myrseth SE, Busse WW. Attitudes and actions of asthma patients on regular maintenance therapy: the INSPIRE study. BMC Pulm Med 2006;6:13. https://doi.org/10.1186/1471-2466-6-13
  16. Cazzoletti L, Marcon A, Janson C, Corsico A, Jarvis D, Pin I, et al. Asthma control in Europe: a real-world evaluation based on an international population-based study. J Allergy Clin Immunol 2007;20:1360-7.
  17. Backer V, Nolte H, Pedersen L, Dam N, Harving H. Unawareness and undertreatment of asthma: follow-up in a different geographic area in Denmark. Allergy 2009;64:1179-84. https://doi.org/10.1111/j.1398-9995.2009.01994.x
  18. Kaplan A, Ryan D. The role of budesonide/formoterol for maintenance and relief in the management of asthma. Pulm Pharmacol Ther 2010;23:88-96. https://doi.org/10.1016/j.pupt.2009.10.011
  19. Mun JS, Choi IS, Sim MK. Recent trend in prevalence and severity of acute asthma in an emergency room. Korean J Asthma Allergy Clin Immunol 2005;25:284-90.
  20. Russo MJ, McConnochie KM, McBride JT, Szilagyi PG, Brooks AM, Roghmann KJ. Increase in admission threshold explains stable asthma hospitalization rates. Pediatrics 1999;104:454-62. https://doi.org/10.1542/peds.104.3.454
  21. Peat JK, van den Berg RH, Mellis CM, Leeder SR, Woolcock AJ. Changes in the prevalence of asthma and allergy in Australian children 1982-1992. Am Rev Respir Dis 1993;147:A800.
  22. International Consensus Report on Diagnosis and Management of Asthma (NIH publication 92-3091). Bethesda, MD: US Department of Health and Human Services, Public Health Service, National Institutes of Health; 1992.
  23. Shin TS, Lee GJ, Yoon HS. A survey of the distribution of allergic diseases in primary schoolchildren. Allergy 1990;10:201-12.
  24. Kemp A, Bjorksten B. Immune deviation and the hygiene hypothesis: a review of the epidemiological evidence. Pediatr Allergy Immunol 2003;14:74-80. https://doi.org/10.1034/j.1399-3038.2003.00017.x
  25. Suh JK, Lee SR, Lee SY, Lee SH, Cho JY, Shim JJ, et al. Clinical Characteristics of Asthmatic Patients Who Visited Emergency Room. Tuberc Respir Dis 1997;4:290-7.
  26. Wennergren G, Kristjansson S, Strannegard IL. Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in prevalence of asthma. J Allergy Clin Immunol 1996;97:742-8. https://doi.org/10.1016/S0091-6749(96)80150-3