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Reactive versus proactive patterns of inhaled corticosteroid use
Chantel D Sloan1, Tebeb Gebretsadik, Pingsheng Wu
1Vanderbilt Center for Asthma & Environmental Sciences Research, Vanderbilt University Medical Center, Vanderbilt University, Nashville, TN 37232-8300, USA.
Annals of the American Thoracic Society
|April 24, 2013
Summary
Pediatric asthma patients show low adherence to inhaled corticosteroids (ICS), often filling prescriptions reactively after exacerbations. Improving ICS adherence, especially before viral seasons, could significantly reduce childhood asthma morbidity.
Area of Science:
- Pediatric Pulmonology
- Public Health
- Health Services Research
Background:
- Inhaled corticosteroids (ICS) are crucial for persistent asthma control, aiming to decrease morbidity.
- However, adherence to daily ICS treatment is notably low in many US populations.
- Seasonal patterns and reactive use of ICS in children warrant investigation.
Purpose of the Study:
- To evaluate seasonal inhaled corticosteroid (ICS) prescription filling as a reactive behavior in pediatric asthma patients.
- To assess the relationship between ICS use and asthma exacerbations in children.
Main Methods:
- Analysis of prescription filling data from Tennessee Medicaid (TennCare) for children aged 6-9 with asthma (2005-2010).
- Asthma exacerbations were identified by systemic rescue corticosteroid (RCS) use.
- Examined seasonal trends and timing of ICS fills relative to RCS fills.
Main Results:
- A cohort of 13,114 children with asthma exhibited seasonal ICS and RCS filling, peaking in fall and winter.
- Average ICS fills were low (three per child), with 54.1% experiencing exacerbations.
- ICS fills predominantly coincided with RCS fills, indicating reactive prescribing.
Conclusions:
- Low and inconsistent adherence to ICS was observed in this pediatric asthma population.
- Seasonal ICS filling patterns align with asthma exacerbation peaks.
- Enhanced ICS adherence, particularly proactive use before viral epidemics, may substantially reduce childhood asthma morbidity.
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