Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Joan Sweeney; Chris C Patterson; Andrew Menzies-Gow; Rob M Niven; Adel H Mansur; Christine Bucknall; Rekha Chaudhuri; David Price; Chris E Brightling; Liam G Heaney; British Thoracic Society Difficult Asthma Network

doi:10.1136/thoraxjnl-2015-207630

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Joan Sweeney, Chris C Patterson, Andrew Menzies-Gow, Rob M Niven, Adel H Mansur, Christine Bucknall, Rekha Chaudhuri, David Price, Chris E Brightling, Liam G Heaney, British Thoracic Society Difficult Asthma Network

Research output: Contribution to journal › Article › peer-review

235 Citations (Scopus)

Abstract

OBJECTIVE: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.

DESIGN: Cross-sectional observational study.

SETTING: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.

PARTICIPANTS: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).

MAIN OUTCOME MEASURES: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.

RESULTS: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.

CONCLUSIONS: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

Original language	English
Pages (from-to)	339-346
Number of pages	8
Journal	Thorax
Volume	71
Issue number	4
Early online date	27 Jan 2016
DOIs	https://doi.org/10.1136/thoraxjnl-2015-207630
Publication status	Published - Apr 2016

Bibliographical note

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

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David Price
- School of Medicine, Medical Sciences & Nutrition, Applied Health Sciences - Chair of Primary Care Respiratory Med
- Institute of Applied Health Sciences
Person: Clinical Academic Related - Scholarship, Clinical Academic

Cite this

Sweeney, J., Patterson, C. C., Menzies-Gow, A., Niven, R. M., Mansur, A. H., Bucknall, C., Chaudhuri, R., Price, D., Brightling, C. E., Heaney, L. G., & British Thoracic Society Difficult Asthma Network (2016). Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. Thorax, 71(4), 339-346. https://doi.org/10.1136/thoraxjnl-2015-207630

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry. / Sweeney, Joan; Patterson, Chris C; Menzies-Gow, Andrew et al.
In: Thorax, Vol. 71, No. 4, 04.2016, p. 339-346.

Research output: Contribution to journal › Article › peer-review

Sweeney, J, Patterson, CC, Menzies-Gow, A, Niven, RM, Mansur, AH, Bucknall, C, Chaudhuri, R, Price, D, Brightling, CE, Heaney, LG & British Thoracic Society Difficult Asthma Network 2016, 'Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry', Thorax, vol. 71, no. 4, pp. 339-346. https://doi.org/10.1136/thoraxjnl-2015-207630

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title = "Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry",

abstract = "OBJECTIVE: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.DESIGN: Cross-sectional observational study.SETTING: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.PARTICIPANTS: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).MAIN OUTCOME MEASURES: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.RESULTS: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.CONCLUSIONS: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.",

author = "Joan Sweeney and Patterson, {Chris C} and Andrew Menzies-Gow and Niven, {Rob M} and Mansur, {Adel H} and Christine Bucknall and Rekha Chaudhuri and David Price and Brightling, {Chris E} and Heaney, {Liam G} and {British Thoracic Society Difficult Asthma Network}",

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doi = "10.1136/thoraxjnl-2015-207630",

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T1 - Comorbidity in severe asthma requiring systemic corticosteroid therapy

T2 - cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

AU - Sweeney, Joan

AU - Patterson, Chris C

AU - Menzies-Gow, Andrew

AU - Niven, Rob M

AU - Mansur, Adel H

AU - Bucknall, Christine

AU - Chaudhuri, Rekha

AU - Price, David

AU - Brightling, Chris E

AU - Heaney, Liam G

AU - British Thoracic Society Difficult Asthma Network

N1 - Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

PY - 2016/4

Y1 - 2016/4

N2 - OBJECTIVE: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.DESIGN: Cross-sectional observational study.SETTING: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.PARTICIPANTS: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).MAIN OUTCOME MEASURES: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.RESULTS: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.CONCLUSIONS: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

AB - OBJECTIVE: To determine the prevalence of systemic corticosteroid-induced morbidity in severe asthma.DESIGN: Cross-sectional observational study.SETTING: The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.PARTICIPANTS: Optimum Patient Care Research Database (7195 subjects in three age- and gender-matched groups)-severe asthma (Global Initiative for Asthma (GINA) treatment step 5 with four or more prescriptions/year of oral corticosteroids, n=808), mild/moderate asthma (GINA treatment step 2/3, n=3975) and non-asthma controls (n=2412). 770 subjects with severe asthma from the British Thoracic Society Difficult Asthma Registry (442 receiving daily oral corticosteroids to maintain disease control).MAIN OUTCOME MEASURES: Prevalence rates of morbidities associated with systemic steroid exposure were evaluated and reported separately for each group.RESULTS: 748/808 (93%) subjects with severe asthma had one or more condition linked to systemic corticosteroid exposure (mild/moderate asthma 3109/3975 (78%), non-asthma controls 1548/2412 (64%); p<0.001 for severe asthma versus non-asthma controls). Compared with mild/moderate asthma, morbidity rates for severe asthma were significantly higher for conditions associated with systemic steroid exposure (type II diabetes 10% vs 7%, OR=1.46 (95% CI 1.11 to 1.91), p<0.01; osteoporosis 16% vs 4%, OR=5.23, (95% CI 3.97 to 6.89), p<0.001; dyspeptic disorders (including gastric/duodenal ulceration) 65% vs 34%, OR=3.99, (95% CI 3.37 to 4.72), p<0.001; cataracts 9% vs 5%, OR=1.89, (95% CI 1.39 to 2.56), p<0.001). In the British Thoracic Society Difficult Asthma Registry similar prevalence rates were found, although, additionally, high rates of osteopenia (35%) and obstructive sleep apnoea (11%) were identified.CONCLUSIONS: Oral corticosteroid-related adverse events are common in severe asthma. New treatments which reduce exposure to oral corticosteroids may reduce the prevalence of these conditions and this should be considered in cost-effectiveness analyses of these new treatments.

U2 - 10.1136/thoraxjnl-2015-207630

DO - 10.1136/thoraxjnl-2015-207630

M3 - Article

C2 - 26819354

SN - 0040-6376

VL - 71

SP - 339

EP - 346

JO - Thorax

JF - Thorax

IS - 4

ER -

Comorbidity in severe asthma requiring systemic corticosteroid therapy: cross-sectional data from the Optimum Patient Care Research Database and the British Thoracic Difficult Asthma Registry

Abstract

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David Price

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