Assessing Asthma Control By Frequency Of High Systemic Corticosteroid And/or SABA Prescriptions In US Administrative Claims Data

Abstract

Guideline-defined assessment of asthma control incorporates elements of symptom burden (impairment) and exacerbation risk. Commonly used questionnaires assess control primarily in terms of impairment but provide little information about varying risk levels. However, use of systemic corticosteroids (SCS) and frequent need for short-acting beta-agonists (SABA) may be indicative of high symptom burden, disease relapse, severity, and exacerbation risk. Using data from a retrospective analysis of IBM/Watson MarketScan® claims database, we explored the extent of uncontrolled asthma, defined according to numbers of SCS and/or SABA prescriptions filled within one year. Of the 579,955 patients included, 54.3% were classed as GINA 1, 24.8% as GINA 2/3, and 20.9% as GINA 4/5. The proportions of GINA 1 patients with prescription fills within one year for ≥2 SCS, ≥3 SABA, or either (≥2 SCS or ≥3 SABA) were 13.5%, 18.8%, and 28.6%, respectively. For GINA 2/3 patients, these proportions were: 19.8%, 31.7%, and 43.4%; and for GINA 4/5 patients: 31.7%, 44.6%, and 59.1%, respectively. Using a stricter definition for impaired asthma control: For GINA 1 patients, 5.1% had ≥3 SCS, 10.3% had ≥4 SABA, and 14.5% had either (≥3 SCS or ≥4 SABA) prescription fills within one year. For GINA 2/3 patients, these proportions were: 9.0%, 18.8%, and 25.1%; and for GINA 4/5 patients: 17.6%, 29.5%, and 39.7%, respectively. These data suggest high prevalence of impaired asthma control and exacerbation risk across all disease gradations, and indicate substantial need for relief medication among cohorts traditionally described as “moderate” or “mild”.