Abstract
<h3>Introduction</h3> The MANDALA study showed decreased exacerbation risk with and as-needed short-acting beta<sub>2</sub>-agonist (SABA)-inhaled corticosteroid (ICS) fixed-dose combination vs as-needed SABA in uncontrolled moderate-to-severe asthma. To understand the broader applicability of these findings, we assessed relationships between severe exacerbations and asthma control, maintenance adherence, and disease severity in patients using as-needed SABA. <h3>Methods</h3> IBM MarketScan databases (2010-2017) for US patients aged ≥12 years receiving SABA for asthma were evaluated. Patients were indexed on a random SABA fill, had 12 months' continuous eligibility pre/post-index, and ≥1 post-index maintenance claim. Control was defined by SABA fills (well-controlled [WC, index SABA only], not well-controlled [NWC, 2–3 SABA], very poorly controlled [VPC, ≥4 SABA]); adherence by maintenance medication possession ratio (MPR: ≥80%, 50-79%, <50%); and disease severity defined by maintenance group. Relationships between control, adherence, severity, and severe exacerbations were analyzed descriptively (Chi-square; significance p≤0.05). <h3>Results</h3> Among 351,870 patients: 31% WC, 35% NWC, 34% VPC; 13% adherence ≥80%, 23% 50–79%, 64% <50%. A lower proportion of VPC patients with ≥80% adherence experienced exacerbations than those with <80% adherence (p<0.0001), but adherence was unrelated to exacerbations for WC (p=0.11) or NWC (p=0.46) patients. Better control coupled with greater adherence was associated with reduced exacerbation occurrence. Across maintenance levels, however, 36–54% of WC patients with ≥80% adherence experienced exacerbations (<b>Figure</b>). <h3>Conclusion</h3> Many asthmatics are at risk for exacerbations irrespective of control, adherence, or disease severity. As-needed SABA-ICS should be considered broadly to mitigate variability in airway inflammation that could lead to asthma exacerbations.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
