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HERO ID
3204651
Reference Type
Journal Article
Title
Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry
Author(s)
Sweeney, J; Patterson, CC; Menzies-Gow, A; Niven, RM; Mansur, AH; Bucknall, C; Chaudhuri, R; Price, D; Brightling, CE; Heaney, LG; British Thoracic Society Difficult Asthma Network
Year
2016
Is Peer Reviewed?
1
Journal
Thorax
ISSN:
0040-6376
EISSN:
1468-3296
Volume
71
Issue
4
Page Numbers
339-346
Language
English
PMID
26819354
DOI
10.1136/thoraxjnl-2015-207630
Abstract
OBJECTIVE:
To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.
DESIGN:
Cross-sectional observational study.
SETTING:
The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
PARTICIPANTS:
Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).
MAIN OUTCOME MEASURES:
Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.
RESULTS:
748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.
CONCLUSIONS:
Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.
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