Abstract
BACKGROUND: Long-term outcomes after stepping down asthma medications are not well described. METHODS: This study was a retrospective time-to-event analysis of individuals diagnosed with asthma who stepped down their asthma controller medications using a US claims database spanning 2000 to 2012. Four-month intervals were established and a step-down event was defined by a ≥ 50% decrease in days-supplied of controller medications from one interval to the next; this definition is inclusive of step-down that occurred without health-care provider guidance or as a consequence of a medication adherence lapse. Asthma stability in the period prior to step-down was defined by not having an asthma exacerbation (inpatient visit, ED visit, or dispensing of a systemic corticosteroid linked to an asthma visit) and having fewer than two rescue inhaler claims in a 4-month period. The primary outcome in the period following stepdown was time-to-first asthma exacerbation. RESULTS: Thirty-two percent of the 26,292 included individuals had an asthma exacerbation in the 24-month period following step-down of asthma controller medication, though only 7% had an ED visit or hospitalization for asthma. The length of asthma stability prior to stepping down asthma medication was strongly associated with the risk of an asthma exacerbation in the subsequent 24-month period: < 4 months' stability, 44%; 4 to 7 months, 34%; 8 to 11 months, 30%; and ≥ 12 months, 21% ( P < .001). CONCLUSIONS: In a large, claims-based, real-world study setting, 32% of individuals have an asthma exacerbation in the 2 years following a step-down event.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 630-639 |
| Number of pages | 10 |
| Journal | Chest |
| Volume | 148 |
| Issue number | 3 |
| DOIs | |
| State | Published - Sep 1 2015 |
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ASJC Scopus subject areas
- Pulmonary and Respiratory Medicine
- Critical Care and Intensive Care Medicine
- Cardiology and Cardiovascular Medicine
Cite this
Long-term outcomes after stepping down asthma controller medications : A claims-based, time-to-event analysis. / Rank, Matthew A; Johnson, Ryan; Branda, Megan; Herrin, Jeph; Van Houten, Holly; Gionfriddo, Michael R.; Shah, Nilay D.
In: Chest, Vol. 148, No. 3, 01.09.2015, p. 630-639.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Long-term outcomes after stepping down asthma controller medications
T2 - A claims-based, time-to-event analysis
AU - Rank, Matthew A
AU - Johnson, Ryan
AU - Branda, Megan
AU - Herrin, Jeph
AU - Van Houten, Holly
AU - Gionfriddo, Michael R.
AU - Shah, Nilay D
PY - 2015/9/1
Y1 - 2015/9/1
N2 - BACKGROUND: Long-term outcomes after stepping down asthma medications are not well described. METHODS: This study was a retrospective time-to-event analysis of individuals diagnosed with asthma who stepped down their asthma controller medications using a US claims database spanning 2000 to 2012. Four-month intervals were established and a step-down event was defined by a ≥ 50% decrease in days-supplied of controller medications from one interval to the next; this definition is inclusive of step-down that occurred without health-care provider guidance or as a consequence of a medication adherence lapse. Asthma stability in the period prior to step-down was defined by not having an asthma exacerbation (inpatient visit, ED visit, or dispensing of a systemic corticosteroid linked to an asthma visit) and having fewer than two rescue inhaler claims in a 4-month period. The primary outcome in the period following stepdown was time-to-first asthma exacerbation. RESULTS: Thirty-two percent of the 26,292 included individuals had an asthma exacerbation in the 24-month period following step-down of asthma controller medication, though only 7% had an ED visit or hospitalization for asthma. The length of asthma stability prior to stepping down asthma medication was strongly associated with the risk of an asthma exacerbation in the subsequent 24-month period: < 4 months' stability, 44%; 4 to 7 months, 34%; 8 to 11 months, 30%; and ≥ 12 months, 21% ( P < .001). CONCLUSIONS: In a large, claims-based, real-world study setting, 32% of individuals have an asthma exacerbation in the 2 years following a step-down event.
AB - BACKGROUND: Long-term outcomes after stepping down asthma medications are not well described. METHODS: This study was a retrospective time-to-event analysis of individuals diagnosed with asthma who stepped down their asthma controller medications using a US claims database spanning 2000 to 2012. Four-month intervals were established and a step-down event was defined by a ≥ 50% decrease in days-supplied of controller medications from one interval to the next; this definition is inclusive of step-down that occurred without health-care provider guidance or as a consequence of a medication adherence lapse. Asthma stability in the period prior to step-down was defined by not having an asthma exacerbation (inpatient visit, ED visit, or dispensing of a systemic corticosteroid linked to an asthma visit) and having fewer than two rescue inhaler claims in a 4-month period. The primary outcome in the period following stepdown was time-to-first asthma exacerbation. RESULTS: Thirty-two percent of the 26,292 included individuals had an asthma exacerbation in the 24-month period following step-down of asthma controller medication, though only 7% had an ED visit or hospitalization for asthma. The length of asthma stability prior to stepping down asthma medication was strongly associated with the risk of an asthma exacerbation in the subsequent 24-month period: < 4 months' stability, 44%; 4 to 7 months, 34%; 8 to 11 months, 30%; and ≥ 12 months, 21% ( P < .001). CONCLUSIONS: In a large, claims-based, real-world study setting, 32% of individuals have an asthma exacerbation in the 2 years following a step-down event.
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UR - http://www.scopus.com/inward/citedby.url?scp=84941670851&partnerID=8YFLogxK
U2 - 10.1378/chest.15-0301
DO - 10.1378/chest.15-0301
M3 - Article
C2 - 25997080
AN - SCOPUS:84941670851
VL - 148
SP - 630
EP - 639
JO - Chest
JF - Chest
SN - 0012-3692
IS - 3
ER -