Only one-third of patients with asthma treated with inhaled corticosteroids (ICS) had a regular or post-exacerbation follow-up visit within a 15-month period. This was the case, regardless of asthma severity, according to Hanna Sandelowsky, MD, PhD. “Guidelines for asthma patients treated with maintenance ICS recommend annual reviews,” she says. “My colleagues and I were interested in how visit patterns in an ICS-treated asthma population were related to applicable asthma guidelines.”
For a paper published in the Journal of Asthma and Allergy, Dr. Sandelowsky and colleagues analyzed EHR data for adult patients (N=51,349) with incident asthma with at least one ICS collection (index date) between 2006 and 2017. The researchers defined asthma exacerbations as ED visits, hospitalizations, or collection of oral corticosteroids (OCS). They used a cumulative incidence function, incident rate ratio, and time-to-event analysis to estimate probability of an asthma-related regular follow-up visit and probability of a follow-up visit after an exacerbation, both within 15 months.
Poor Quality of Maintenance Asthma Treatment & Control
Within this follow-up period, 17,573 patients (mild-moderate, 33.9%; severe, 40.4%) had a regular asthma visit in primary or secondary care. The researchers noted that patients who attended follow-up visits had higher ICS collection and lower OCS collection than patients without regular visits.
“We also observed only one of three patients with an acute asthma exacerbation had a follow-up visit with a [healthcare] provider and only two out of five patients with severe exacerbations had a follow-up visit,” the study authors wrote. “This indicates a poor quality of maintenance asthma treatment and poor asthma control in patients without asthma reviews.”
The study team observed that the probability of a visit within 15 months after an exacerbation was 31.0% among 22,097 patients with acute exacerbations, adding that during the study period, the odds of having a visit increased.
“The consequences of this lack of adherence to guidelines need further evaluation to secure optimal asthma management,” the authors concluded.