Uncontrolled Status, Disease Burden, and Associated Risk Factors Among Patients with Asthma Receiving Medium-to-High...

There is limited information on the uncontrolled status and burden of asthma among patients using inhaled corticosteroids (ICS) combined or not with long-acting β2-agonists (LABA) in China. This study aims to characterize the disease burden among these patients and identify risk factors for unfavorable outcomes.

This retrospective observational study utilized data from a regional Electronic Medical Record (EMR) database in China. Patients (≥ 12 years) with asthma having at least two prescriptions for medium-to-high dose ICS or ICS/LABA within any 6 months were identified from the Shanghai Medical Database between 2016 and 2020. Data on characteristics and treatment patterns 1-year pre-index (baseline) and disease burden 1-year post-index (follow-up) were obtained from the database. Uncontrolled asthma was defined based on exacerbations and specific treatment. A multivariate logistic regression model was used to identify risk factors associated with the follow-up adverse outcomes.

A total of 35,900 patients with asthma receiving medium-to-high dose ICS or ICS/LABA were included. Of these, 10,842 (30.2%) were uncontrolled at baseline, exhibiting higher proportions of follow-up uncontrolled asthma (32.3% vs. 10.7%), corticosteroids use (16.8% vs. 3.9%), emergency room (ER) visits and hospitalizations due to exacerbations (22.3% vs. 5.2%), and total medical costs (9303.9 CNY vs. 8621.4 CNY) compared to patients who were controlled, all with p < 0.001. Type 2 (T2) biomarkers detection rates were less than 10% during follow-up. Uncontrolled asthma, older age, T2-related comorbidities, use of ≥ 2 controllers, a short-acting β2-agonist (SABA), and corticosteroids at baseline were significantly related to follow-up adverse outcomes.

A significant proportion of patients with asthma using medium-to-high dose ICS or ICS/LABA in China remain uncontrolled, resulting in greater disease and economic burden. Insufficient assessment of T2 inflammation and suboptimal treatment patterns represent the challenges in asthma management in China, potentially resulting in long-term adverse outcomes.