October 03, 2023

4 min read

AstraZeneca funded this study. Lanz reports having financial relationships with Amgen, AstraZeneca, Novartis, OptiNose, Regeneron and Sanofi. Please see the study for all other authors’ relevant financial disclosures.

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Key takeaways:

  • 42.6% of patients filled a SABA prescription 30 days before an exacerbation, and 61.4% did so within 30 days afterward.
  • 42.6% of patients did not claim for a maintenance medication prior to an exacerbation.

Many patients with moderate to severe asthma failed to use inhaled corticosteroids in addition to a short-acting beta 2 agonist as a rescue to prevent exacerbations, according to a study published in Annals of Allergy, Asthma & Immunology.

There seems to be a “window of opportunity” when this combination has the greatest odds for preventing exacerbations, Miguel J. Lanz, MD, physician-researcher in allergy and asthma at AAADRS Clinical Research Center, and colleagues wrote.

Child using an asthma inhaler

There may be a window of opportunity where a combination of inhaled corticosteroids and a short-acting beta 2 agonist may prevent impending exacerbations. Image: Adobe Stock

Miguel J. Lanz

“There is a need to prevent asthma exacerbations with their accompanying systemic steroids as treatment by identifying the so-called ‘window of opportunity’ for patients to self-administer lower doses of anti-inflammatory medication prior to their exacerbation and subsequent systemic steroid use,” Lanz told Healio.

Study design, findings

Lanz and colleagues used 2011 to 2017 data from Merative MarketScan research databases to evaluate patterns of as-needed short-acting beta 2 agonist (SABA) and maintenance therapy treatment claims among patients with moderate to severe asthma before and after an exacerbation that required a face-to-face clinical encounter.

The study comprised 95,887 children aged 4 to 11 years (mean age, 7.2 years) and 223,455 adolescents and adults aged 12 years and older (mean age, 41.6 years).

The full cohort included 164,485 patients (51.5%) with one or more severe exacerbations and 63,561 (19.9%) with one or more serious exacerbations.

Children appeared more likely to experience severe exacerbations (55% vs. 50%; OR = 1.22; 95% CI, 1.2-1.24) and serious exacerbations (27.2% vs. 16.8%; OR = 1.85; 95% CI, 1.81-1.88) compared with adolescents and adults.

The cumulative proportions of patients who filled prescriptions for a SABA and for a maintenance medication increased as they approached the exacerbation event, the researchers found.

Specifically, within 30 days prior to the serious exacerbation, the cumulative proportion of patients with one or more SABA fills was 42.6%, with a corresponding 57.4% of patients with maintenance fills, indicating 42.6% of patients did not claim for a maintenance medication. Overall, 52.1% of these patients with a SABA claim filed those claims during the 10 days before the event.

“From our extensive U.S. pharmacy data with 2 years’ worth of claims, more than 40% of asthmatics were not filling any anti-inflammatory medications 30 days prior to their exacerbation,” Lanz said.

Children appeared more likely to have one or more SABA fills (44.3% vs. 41.5%; OR = 1.12; 95% CI, 1.09-1.16) and one or more maintenance medication fills (59% vs. 56.3%; OR = 1.12; 95% CI, 1.08-1.15) in the month before exacerbation events compared with adolescents or adults.

During the 30 days that followed exacerbations, 61.4% of patients overall filled a SABA, including 69.7% of children and 55.6% of adults (OR = 1.84; 95% CI, 1.78-1.9). Similarly, 94.8% filled a maintenance therapy, including 98.6% of children and 92.2% of adolescents and adults (OR = 6.09; 95% CI, 5.45-6.81).

All groups appeared more likely to fill a SABA claim between 1 and 10 days after an event compared with between 1 and 10 days before an event (full cohort: OR = 5.89; 95% CI, 5.68-6.12; children: OR = 8.04; 95% CI, 7.57-8.54; adolescents and adults: OR = 4.73; 95% CI, 4.5-4.96).

Similarly, 53.5% of patients with a maintenance therapy claim made that fill in the 10-day period before the serious exacerbation compared with 97.3% in the 10-day period afterward (OR = 31.59; 95% CI, 29.94-33.33), with similar patterns observed among the children (OR = 102.17; 95% CI, 89.03-117.24) and the adolescent and adult (OR = 20.68; 95% CI, 19.48-21.96) groups.

Despite these increases in maintenance fills after exacerbation events, the researchers wrote, 30.6% of the cohort had multiple exacerbations during the post-index period.

Conclusions, next steps

These patterns indicate that many patients with moderate to severe asthma escalate their SABA claims before they experience a serious exacerbation, the researchers wrote, but the approximately 40% of those patients who did not have a maintenance fill indicate that there is a window of opportunity where the use of inhaled corticosteroids with SABA as a rescue may prevent exacerbations.

“At present, according to claims data, there is a much lower percent of therapeutic anti-inflammatory medication use than SABA medication, such as albuterol, which does not treat the underlying inflammation,” Lanz said.

Lanz also called the large percentage of patients with asthma who only use SABA before a flareup “eye opening.”

“Moreover, the great percent of young, school-aged children having any severe/serious asthma exacerbations compared to adults/adolescents is a sobering reality of the state of pediatric asthma regimens, which needs addressing,” he said.

Awareness of this underlying inflammation as the causative factor for exacerbations is key, Lanz continued.

“This concept of a window of opportunity to treat both the respiratory symptoms of asthma plus the underlying airway inflammation only prior to the full-blown exacerbation will be a paradigm shift in asthma care,” he said. “Furthermore, a new therapeutic regimen addressing this will give us the opportunity to empower patients by its use and the possibility to improve outcomes.”

Lanz additionally called for further research to investigate pharmacy claims as well as clinical studies along these avenues, particularly among children aged younger than 12 years.

For more information:

Miguel J. Lanz, MD, can be reached at [email protected].

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