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Relative exposure to controller therapy and asthma exacerbations: a validation study in community pharmacies
Laurent Laforest1, Idlir Licaj, Gilles Devouassoux
1Lyon Pharmaco-Epidemiology Unit, UMR 5558 CNRS, Claude Bernard, Lyon 1 University, Lyon, France.
Pharmacoepidemiology and Drug Safety
|June 20, 2014
Summary
High controller-to-total asthma drug ratios indicate better asthma control and fewer exacerbations. This study validates using these ratios, derived from pharmacy data, to identify at-risk patients.
Area of Science:
- Pulmonary Medicine
- Pharmacoeconomics
- Health Informatics
Background:
- Asthma management relies on controller medications, but identifying patients at risk of exacerbations using claims data can be challenging.
- Controller-to-total asthma drug ratios offer a potential method to assess adherence and risk.
- Linking these ratios to patient-reported outcomes is crucial for interpretation.
Purpose of the Study:
- To investigate the relationship between controller-to-total asthma drug ratios (R1 and R2) and asthma control.
- To compare these ratios with secondary outcomes like hospital contacts and oral corticosteroid use.
- To validate the utility of these ratios in identifying patients with poorly controlled asthma.
Main Methods:
- A survey was conducted in community pharmacies, recruiting patients with anti-asthma drug prescriptions.
- Dispensing data were linked to patient-reported outcomes, including asthma control (Asthma Control Test).
- Patients were categorized into low-controller-ratio (R < 50%) and high-controller-ratio (R ≥ 50%) groups for analysis.
Main Results:
- A high controller-to-total asthma drug ratio (R1 or R2) was significantly associated with better asthma control (lower risk of being uncontrolled).
- Patients in high-controller-ratio groups reported fewer asthma-related outcomes, including hospital contacts and oral corticosteroid use.
- The R1 ratio (inhaled corticosteroids/total asthma drug) and R2 ratio (ICS + leukotriene receptor antagonist/total asthma drug) showed similar predictive utility.
Conclusions:
- Higher controller-to-total asthma drug ratios correlate with improved asthma control and reduced exacerbation risk.
- These ratios, particularly when derived from pharmacy dispensing data, are valuable tools for identifying patients needing closer asthma management.
- The findings support the use of R1 and R2 ratios in claims data analysis for proactive asthma care.
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