Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

BackgroundIn short-term studies, poor adherence to inhaled corticosteroids (ICS) has been associated with worse asthma control, but the association of long-term adherence and disease control remains unclear.ObjectiveTo assess the relationship between 12-year adherence to ICS and asthma control in patients with adult-onset asthma.MethodsAs part of the Seinäjoki Adult Asthma Study, 181 patients with clinically confirmed new-onset adult asthma and regular ICS medication were followed-up for 12 years. Adherence (%) to ICS was assessed individually ((µg dispensed/µg prescribed)×100) during the follow-up. Asthma control was evaluated after 12 years of treatment according to the Global Initiative for Asthma 2010 guideline.ResultsAsthma was controlled in 31% and not controlled (partly controlled or uncontrolled) in 69% of the patients. Patients with not-controlled asthma were more often male, older, nonatopic and used higher doses of ICS than those with controlled disease. The mean±sd 12-year adherence to ICS was 63±38% in patients with controlled asthma and 76±40% in patients with not-controlled disease (p=0.042). Among patients with not-controlled asthma, those with lower 12-year adherence (<80%) had more rapid decline in forced expiratory volume in 1 s (−47 mL·year−1) compared to patients with better adherence (≥80%) (−40 mL·year−1) (p=0.024). In contrast, this relationship was not seen in patients with controlled asthma.ConclusionsIn adult-onset asthma, patients with not-controlled disease showed better 12-year adherence to ICS treatment than those with controlled asthma. In not-controlled disease, adherence <80% was associated with more rapid lung function decline, underscoring the importance of early recognition of such patients in routine clinical practice.

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12-year adherence to inhaled corticosteroids in adult-onset asthma

ERJ Open Research ◽

10.1183/23120541.00324-2019 ◽

2020 ◽

Vol 6 (1) ◽

pp. 00324-2019

Author(s):

Iida Vähätalo ◽

Pinja Ilmarinen ◽

Leena E. Tuomisto ◽

Minna Tommola ◽

Onni Niemelä ◽

...

Keyword(s):

Lung Function ◽

Inhaled Corticosteroids ◽

Immunoglobulin E ◽

Linear Regression Analysis ◽

Forced Expiratory Volume ◽

Rapid Decline ◽

Blood Eosinophil ◽

Adult Onset ◽

Lung Function Decline ◽

Adult Asthma

Adherence to inhaled corticosteroids (ICS) has been suggested to be poor but long-term follow-ups are lacking. The objective of the present study was to assess adherence to ICS treatment in patients with adult-onset asthma during 12-year follow-up.A total of 181 patients with clinically confirmed, new-onset adult asthma were followed for 12 years as part of the Seinäjoki Adult Asthma Study. Adherence to ICS was assessed individually as the percentage of true dispensed ICS in micrograms per true prescribed daily ICS in micrograms over 12 years.Mean 12-year adherence to ICS was 69% (mean±sd dispensed 2.5±1.8 g and prescribed 3.6±1.5 g budesonide equivalent per patient for 12 years), annual adherence varying between 81% (year 1) and 67% (year 12). Patients with good 12-year adherence (≥80%) used oral corticosteroids more often, and had add-on drugs in use and asthma-related visits to healthcare more often. In addition, they showed less reversibility in forced expiratory volume in 1 s and had higher peripheral blood neutrophil counts. However, lung function decline was steeper in patients with poorer adherence (<80%) and this association remained in multiple linear regression analysis. No difference was found in symptom scores, blood eosinophil counts, exhaled nitric oxide or immunoglobulin E between the patients with different levels of adherence.In patients with adult-onset asthma, adherence to ICS was moderate. Poorer adherence (<80%) to ICS was associated with more rapid decline in lung function but was not associated to symptoms or markers of inflammatory endotypes.

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The effect of smoking on lung function: a clinical study of adult-onset asthma

European Respiratory Journal ◽

10.1183/13993003.00850-2016 ◽

2016 ◽

Vol 48 (5) ◽

pp. 1298-1306 ◽

Cited By ~ 32

Author(s):

Minna Tommola ◽

Pinja Ilmarinen ◽

Leena E. Tuomisto ◽

Jussi Haanpää ◽

Terhi Kankaanranta ◽

...

Keyword(s):

Lung Function ◽

Multivariate Regression Analysis ◽

Forced Expiratory Volume ◽

Smoking History ◽

Adult Onset ◽

Lung Function Decline ◽

Adult Asthma ◽

Asthma Patients ◽

Annual Decline

The aim of this study was to evaluate the effect of smoking on lung function decline in adult-onset asthma in a clinical, 12-year follow-up study.In the Seinäjoki Adult Asthma Study, 203 patients were followed for 12 years (1999–2013) after diagnosis of new-onset adult asthma. Patients were divided into two groups based on smoking history: <10 or ≥10 pack-years. Spirometry evaluation points were: 1) baseline, 2) the maximum lung function during the first 2.5 years after diagnosis (Max0–2.5) and 3) after 12 years of follow-up.Between Max0–2.5 and follow-up, the median annual decline in absolute forced expiratory volume in 1 s (FEV1) was 36 mL in the group of patients with <10 pack-years of smoking and 54 mL in those with smoking history ≥10 pack-years (p=0.003). The annual declines in FEV1 % pred (p=0.006), forced vital capacity (FVC) (p=0.035) and FEV1/FVC (p=0.045) were also accelerated in the group of patients with ≥10 pack-years smoked. In multivariate regression analysis, smoking history ≥10 pack-years became a significant predictor of accelerated decline in FEV1.Among patients with clinically defined adult-onset asthma, smoking history ≥10 pack-years is associated with accelerated loss of lung function.

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Asthma progression and mortality: the role of inhaled corticosteroids

European Respiratory Journal ◽

10.1183/13993003.00491-2019 ◽

2019 ◽

Vol 54 (1) ◽

pp. 1900491 ◽

Cited By ~ 16

Author(s):

Paul O'Byrne ◽

Leonardo M. Fabbri ◽

Ian D. Pavord ◽

Alberto Papi ◽

Stefano Petruzzelli ◽

...

Keyword(s):

Lung Function ◽

Pulmonary Function ◽

Inhaled Corticosteroids ◽

Administrative Databases ◽

Rapid Decline ◽

Lung Function Decline ◽

The Impact ◽

Asthma Mortality

Overall, asthma mortality rates have declined dramatically in the last 30 years, due to improved diagnosis and to better treatment, particularly in the 1990s following the more widespread use of inhaled corticosteroids (ICSs). The impact of ICS on other long-term outcomes, such as lung function decline, is less certain, in part because the factors associated with these outcomes are incompletely understood. The purpose of this review is to evaluate the effect of pharmacological interventions, particularly ICS, on asthma progression and mortality. Furthermore, we review the potential mechanisms of action of pharmacotherapy on asthma progression and mortality, the effects of ICS on long-term changes in lung function, and the role of ICS in various asthma phenotypes.Overall, there is compelling evidence of the value of ICS in improving asthma control, as measured by improved symptoms, pulmonary function and reduced exacerbations. There is, however, less convincing evidence that ICS prevents the decline in pulmonary function that occurs in some, although not all, patients with asthma. Severe exacerbations are associated with a more rapid decline in pulmonary function, and by reducing the risk of severe exacerbations, it is likely that ICS will, at least partially, prevent this decline. Studies using administrative databases also support an important role for ICS in reducing asthma mortality, but the fact that asthma mortality is, fortunately, an uncommon event makes it highly improbable that this will be demonstrated in prospective trials.

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Differences between asthma–COPD overlap syndrome and adult-onset asthma

European Respiratory Journal ◽

10.1183/13993003.02383-2016 ◽

2017 ◽

Vol 49 (5) ◽

pp. 1602383 ◽

Cited By ~ 25

Author(s):

Minna Tommola ◽

Pinja Ilmarinen ◽

Leena E. Tuomisto ◽

Lauri Lehtimäki ◽

Jussi Haanpää ◽

...

Keyword(s):

Lung Function ◽

Vital Capacity ◽

Forced Expiratory Volume ◽

Overlap Syndrome ◽

Smoking History ◽

Adult Onset ◽

Blood Neutrophil ◽

Diffusing Capacity ◽

Adult Asthma ◽

Asthma Patients

Differences between asthma–COPD overlap syndrome (ACOS) and adult-onset asthma are poorly understood. This study aimed to evaluate these differences in a clinical cohort of patients with adult-onset asthma, as a part of the Seinäjoki Adult Asthma Study (SAAS).188 patients were diagnosed with adult-onset asthma and re-evaluated 12 years after diagnosis. They were divided into three groups based on smoking history and post bronchodilator spirometry values: 1) never- and ex-smokers with <10 smoked pack-years; 2) non-obstructive (forced expiratory volume in 1 s (FEV1)/forced vital capacity (FVC) ≥0.7) patients with ≥10 pack-years; and 3) ACOS patients with ≥10 pack-years and FEV1/FVC <0.7.ACOS patients had lower diffusing capacity (DLCO/VA 86% predicted versus 98 or 96% predicted; p<0.001), higher blood neutrophil levels (4.50 versus 3.60 or 3.85×109 L−1; p=0.008), and higher IL-6 levels (2.88 versus 1.52 or 2.10 pg·mL−1, p<0.001) as compared to never- and ex-smokers with <10 pack-years, or non-obstructive patients with ≥10 pack-years smoking history, respectively. ACOS patients also showed reduced lung function, higher remaining bronchial reversibility and a higher number of comorbidities.This study shows distinct differences in diffusing capacity, blood neutrophil and IL-6 levels, bronchial reversibility, lung function and comorbidities between ACOS and adult-onset asthma. The present findings should be considered in the comprehensive assessment of adult asthma patients.

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Fluticasone versus Salmeterol/Low-Dose Fluticasone for Long-Term Asthma Control

Annals of Pharmacotherapy ◽

10.1345/aph.1a311 ◽

2002 ◽

Vol 36 (12) ◽

pp. 1944-1949 ◽

Cited By ~ 9

Author(s):

Catherine A Heyneman ◽

Rachel Crafts ◽

Jerry Holland ◽

Aaron D Arnold

Keyword(s):

Fluticasone Propionate ◽

Asthma Control ◽

Low Dose ◽

Inhaled Corticosteroids ◽

Symptom Control ◽

Persistent Asthma ◽

Forced Expiratory Volume ◽

Combination Drug ◽

Medium Dose

OBJECTIVE: To evaluate the relative clinical superiority of increasing the dose of fluticasone propionate versus the addition of salmeterol to low-dose fluticasone propionate for long-term asthma control. DATA SOURCES: Literature was identified by a MEDLINE search (1966–October 2002). Key search terms included asthma, inhalation, corticosteroid, β-adrenergic agonist, and combination drug therapy. DATA SYNTHESIS: Current guidelines for long-term control of asthma include treatment with either inhaled corticosteroids (medium dose) or inhaled corticosteroids (low to medium dose) in combination with a long-acting bronchodilator. Previous studies evaluating salmeterol or formoterol combination therapy with beclomethasone or budesonide have generally produced superior results compared with increasing the dose of the inhaled corticosteroid. Four recent controlled clinical trials have compared the clinical utility of fluticasone propionate monotherapy versus salmeterol/low-dose fluticasone propionate for long-term asthma control in patients with moderate to severe persistent asthma. Based on spirometry data, rescue albuterol use, and symptom scores, the addition of salmeterol to low-dose fluticasone propionate was superior to increasing the dose of fluticasone propionate. CONCLUSIONS: Based on improvements in forced expiratory volume in 1 second, peak expiratory flow, and symptom control, the addition of salmeterol to low-dose fluticasone propionate provides better control of asthma than increasing the dose of fluticasone propionate.

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Long-term adherence to inhaled corticosteroids and asthma control in adult-onset asthma

10.1183/13993003.congress-2020.2636 ◽

2020 ◽

Author(s):

Iida Vähätalo ◽

Hannu Kankaanranta ◽

Leena Esteri Tuomisto ◽

Onni Niemelä ◽

Lauri Lehtimäki ◽

...

Keyword(s):

Asthma Control ◽

Inhaled Corticosteroids ◽

Adult Onset

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Long-term prognosis of new adult-onset asthma in obese patients

European Respiratory Journal ◽

10.1183/13993003.01209-2020 ◽

2020 ◽

pp. 2001209

Author(s):

Pinja Ilmarinen ◽

Adrienn Pardo ◽

Leena E. Tuomisto ◽

Iida Vähätalo ◽

Onni Niemelä ◽

...

Keyword(s):

Hospital Admissions ◽

Oral Corticosteroid ◽

Normal Weight ◽

Adult Onset ◽

Cross Sectional ◽

Asthma Patients ◽

Long Term Prognosis ◽

Poor Outcomes

BackgroundObesity has been associated with poor outcomes of asthma in cross-sectional studies but long-term effect of obesity on asthma remains unknown.AimsTo study the effects of obesity, found at the time of diagnosis of adult-onset asthma, on 12-year prognosis by focusing on oral corticosteroid (OCS) use and respiratory-related hospital admissions.MethodsPatients diagnosed with adult-onset asthma (n=203) were divided into three categories based on diagnostic BMI (<25, 25–29.9, ≥30 kg·m−2) and followed for 12-years as part of Seinäjoki Adult Asthma Study. Self-reported and dispensed OCS were assessed for the 12-year period. Data on hospital admissions were analysed based on medical records.Results12 years after diagnosis, of the patients obese (≥30 kg·m−2) at diagnosis, 86% remained obese. During the follow-up, no difference was found in the weight gain between the BMI categories. During the 12-year follow-up, patients obese at diagnosis reported more often use of OCS courses (46.9% versus 23.1%, p=0.028), were dispensed OCS more often (81.6% versus 56.9%, p=0.014) and at higher doses (median 1350 (IQR 280–3180)mg versus 600 (0–1650)mg prednisolone, p=0.010) compared to normal-weight patients. Furthermore, obese had more often ≥1 respiratory-related hospitalisation compared to normal-weight patients (38.8% versus 16.9%, p=0.033). In multivariate logistic regression analyses, obesity predicted oral corticosteroid use and hospital admissions.ConclusionsIn adult-onset asthma, patients obese at diagnosis mostly remained obese at long-term and had more exacerbations and respiratory-related hospital admissions compared to normal-weight patients during 12-year follow-up. Weight loss should be a priority in their treatment to prevent this outcome.

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