Patterns of Rescue and Maintenance Medication Claims Surrounding an Asthma Exacerbation in Patients Treated as Intermittent or Mild Persistent Asthma

IF 3.7 3区医学 Q2 ALLERGY

Journal of Asthma and Allergy Pub Date : 2024-09-14 DOI:10.2147/jaa.s470975

Miguel J Lanz, Michael Pollack, Ileen A Gilbert, Hitesh N Gandhi, Joseph P Tkacz, Njira L Lugogo

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引用次数: 0

Abstract

Purpose: To examine patterns of short-acting ß₂-agonist (SABA) and maintenance therapy claims surrounding the subset of severe asthma exacerbations associated with outpatient, urgent care, or emergency department visits or hospitalization (termed serious exacerbations) in patients treated as intermittent or mild persistent asthma.
Methods: This was a retrospective study of 2010– 2017 administrative claims from Merative^TM MarketScan^® US databases for patients ≥ 12 years filling a SABA prescription for asthma (index). Patients had ≥ 12 months continuous insurance eligibility pre- and post-index and ≥ 1 additional SABA and/or maintenance medication fill appropriate for mild persistent asthma post-index. Prescription fills were assessed over 30 days before and after a serious exacerbation event.
Results: Of 323,443 patients (mean [standard deviation] age: 34.9 [18.2] years; 62.0% female) treated as intermittent or mild persistent asthma, 51,690 (16.0%) experienced ≥ 1 serious exacerbation post-index. During the 30 days pre-event, a greater proportion of patients filled a SABA versus maintenance therapy (24.6% vs 19.0%; odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.35– 1.43; p < 0.001); during the 30 days post-event, patients were more likely to fill maintenance medication versus SABA (88.6% vs 67.0%; OR [95% CI]: 3.88 [3.75– 4.01]; p < 0.001). The closer in time prior to the event, the greater the likelihood of filling a SABA versus maintenance prescription (OR [95% CI]; 1– 7 days pre-event: 1.42 [1.36– 1.48]; 8– 14 days pre-event: 1.34 [1.27– 1.41]; 15– 30 days pre-event: 1.18 [1.12– 1.24]; all p < 0.001). Over 4.5 times more patients filled a maintenance therapy within 7 days post-event (45,014) versus all 30 days pre-event (9835) (OR [95% CI]: 28.7 [27.7– 29.7]; p < 0.001).
Conclusion: These patterns of SABA rescue and maintenance fills suggest that a “window of opportunity” may exist to interrupt a serious exacerbation occurrence for patients treated as intermittent or mild persistent asthma if symptoms and inflammation are addressed concomitantly.

Keywords: asthma, corticosteroid, inflammation, maintenance therapy, rescue therapy, short-acting ß₂-agonist

查看原文本刊更多论文

间歇性哮喘或轻度持续性哮喘患者在哮喘恶化期间的抢救和维持用药模式

目的：研究间歇性或轻度持续性哮喘患者因门诊、急诊或急诊科就诊或住院（称为严重加重）引起的严重哮喘加重子集的短效ß2-激动剂（SABA）和维持治疗索赔模式：这是一项回顾性研究，从 MerativeTM MarketScan® US 数据库中提取了 2010 年至 2017 年的行政索赔，对象是年龄≥ 12 岁的哮喘患者，并开具了 SABA 处方（索引）。患者在指数前后连续获得保险资格的时间≥ 12 个月，且在指数后≥ 1 次额外的 SABA 和/或适合轻度持续性哮喘的维持用药。对严重恶化事件发生前后 30 天内的处方用药情况进行了评估：在 323,443 名接受间歇性或轻度持续性哮喘治疗的患者（平均 [标准差] 年龄：34.9 [18.2] 岁；62.0% 为女性）中，51,690 人（16.0%）在指标公布后经历了≥ 1 次严重恶化。在事件发生前的 30 天内，接受 SABA 治疗与维持治疗的患者比例更高（24.6% 对 19.0%；赔率比 [OR]：1.39，95% 置信区间 [CI]：1.35-1.43；p <0.001）；在事件发生后的 30 天内，患者更有可能使用维持治疗药物而非 SABA（88.6% vs 67.0%；OR [95% CI]：3.88 [3.75-4.01]；p <0.001）。距离事件发生时间越近，开具 SABA 处方的可能性就越大（OR [95% CI]；事件发生前 1-7 天：1.42 [1.36- 4.01]；P <；0.001）：1.42[1.36-1.48]；事件发生前 8-14 天：1.34 [1.27- 1.41]；15- 30 天前：所有 p 均为 0.001）。事件发生后 7 天内接受维持治疗的患者（45,014 例）是事件发生前所有 30 天内接受维持治疗的患者（9835 例）的 4.5 倍多（OR [95% CI]：28.7 [27.7- 29.7]；P <；0.001）：哮喘、皮质类固醇、炎症、维持治疗、抢救治疗、短效ß2-激动剂

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来源期刊

Journal of Asthma and Allergy Medicine-Immunology and Allergy

CiteScore

5.30

自引率

6.20%

发文量

185

审稿时长

16 weeks

期刊介绍： An international, peer-reviewed journal publishing original research, reports, editorials and commentaries on the following topics: Asthma; Pulmonary physiology; Asthma related clinical health; Clinical immunology and the immunological basis of disease; Pharmacological interventions and new therapies. Although the main focus of the journal will be to publish research and clinical results in humans, preclinical, animal and in vitro studies will be published where they shed light on disease processes and potential new therapies.