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Persistence with inhaled corticosteroids

Clinical bottom line

Half of patients used inhaled corticosteroids for fewer than 200 days, and only 18% continued treatment for one year. Patients with a history of multiple respiratory drugs had a higher one-year persistence rate of 40%.


Background

Although asthma and COPD are common, and inhaled corticosteroids are effective in reducing exacerbations and improving quality of life, adherence seems to be poor.

Reference

NS Breekveldt-Postma et al. Persistence with inhaled corticosteroid therapy in daily practice. Respiratory Medicine 2004 98: 752-759.


Study

As part of medical record linkage scheme, information was available on 325,000 inhabitants of 12 Dutch cities. The study period was the eight years of 1993-2001. Patients age at least 5 years who received their first prescription and dispensing of inhaled corticosteroids before 2001 formed the cohort.

Persistence was defined as the number of days that inhaled corticosteroid was used in the period of one year after the first dispensing. One year persistence rates were the percentage that patients used inhaled corticosteroids for at least 365 days.

Results

There were 8,736 patients in the cohort, with ages over the range of five years to over 65 years. There was considerable information about the type of steroid, the inhaler type, dose, prescriber, and prior history of respiratory disease and prescribing. Most patients had low to moderate disease severity because they had only one asthma or COPD drug before inhaled corticosteroids.

The one year persistence rate was lowest (10%) in patients who had previously been prescribed only a cough medicine. It was about 15% in those with undefined prior therapy (antihistamines or mucolytics) or one prior respiratory disease drug, about 25% in those with multiple respiratory disease drugs, and about 40% in those with multiple prior respiratory disease drugs plus oral corticosteroids and antibiotics.

Comment

Respiratory disease patients seem to stick with their inhaled corticosteroid when they are in trouble. In this case it was more severe disease (and previous hospital admission and increasing age).