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Does adherence to inhaled corticosteroids predict asthma-related outcomes over time? A cohort study
- Source :
- European Respiratory Journal, 54, 6, European respiratory journal, 54(6). European Respiratory Society, European Respiratory Journal, 54
- Publication Year :
- 2019
-
Abstract
- Inhaled corticosteroids (ICS) adherence is important for asthma management. Current evidence on the impact of ICS adherence on outcomes is mostly based on correlational analyses of between-person data. Although it is widely acknowledged that asthma outcomes fluctuate over time, evidence on predictors of within-person change is scarce. We aimed to quantify these fluctuations and the longitudinal relationships between ICS adherence and outcomes at both between- and within-person levels.A prospective cohort of persistent asthma patients in France and the UK (n=847, age 6−40 years) provided 3756 reports over up to 2 yearsviacomputer-assisted telephone interviews and text messages on ICS adherence, asthma control, reliever medication use and exacerbations. We examined adherence−outcome relationshipsvialongitudinal models, controlling for confounders, including severity.Considerable within-person variability was found for exacerbations (91%), asthma control (59%) and reliever use (52%); 431 (11.5%) reports signalled exacerbations and 2046 (54.5%) poor control. At between-person level, patients with higher average adherence were more likely to report asthma control (OR 1.25, 95% CI 1.06−1.47), but not asthma exacerbations (OR 0.99, 95% CI 0.87−1.12) or lower reliever use (b −0.0004, 95% CI −0.089−0.088). At within-person level, higher-than-usual adherence was associated with higher concomitant reliever use (b 0.092, 95% CI 0.053−0.131) and lower subsequent reliever use (b −0.047, 95% CI −0.005− −0.088); it was unrelated to asthma control (OR 0.93, 95% CI 0.84−1.02) or exacerbations (OR 1.04, 95% CI 0.94−1.16).Patients maintaining high ICS adherence over time have better asthma control. Temporarily increasing ICS adherence tends to be simultaneous to higher reliever use and reduces reliever use later on. Causes of within-person variation in outcomes require more investigation.
- Subjects :
- Adult
Pulmonary and Respiratory Medicine
medicine.medical_specialty
Time Factors
Adolescent
Inhaled corticosteroids
Medication Adherence
Healthcare improvement science Radboud Institute for Health Sciences [Radboudumc 18]
Cohort Studies
Young Adult
03 medical and health sciences
0302 clinical medicine
Adrenal Cortex Hormones
Internal medicine
Asthma control
Administration, Inhalation
medicine
Humans
Anti-Asthmatic Agents
030212 general & internal medicine
Child
Prospective cohort study
Asthma
Asthma exacerbations
business.industry
Confounding
medicine.disease
United Kingdom
3. Good health
Treatment Outcome
030228 respiratory system
Concomitant
France
business
Cohort study
Subjects
Details
- ISSN :
- 09031936
- Database :
- OpenAIRE
- Journal :
- European Respiratory Journal, 54, 6, European respiratory journal, 54(6). European Respiratory Society, European Respiratory Journal, 54
- Accession number :
- edsair.doi.dedup.....3ade96f57e66d5d7428a9b28559121db