Daily Dose: Maintenance Therapy Utilization Suboptimal Before Asthma Exacerbations

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Patient Care brings primary care clinicians a lot of medical news every day—it’s easy to miss an important study. The Daily Dose provides a concise summary of one of the website's leading stories you may not have seen.

On October 4, 2023, we reported on a study published in the Annals of Allergy, Asthma & Immunology that evaluated rescue and maintenance therapy claims surrounding a severe asthma exacerbation serious enough to require a face-to-face clinical encounter.

The study

Investigators evaluated the patterns of as-needed short-acting beta-2 agonists (SABA) and maintenance therapy treatment claims in patients with moderate-to-severe asthma before and after a severe exacerbation serious enough to result in a face-to-face clinical encounter; they compared findings between children aged 4 to 11 years and adults or adolescents aged ≥12 years.

The research team collected participant data from Merative MarketScan research databases for claims made between 2011 and 2017. Investigators identified 319 342 individuals with diagnostic codes for moderate-to-severe asthma; the group was comprised of 95 887 children aged 4 to 11 years (mean age, 7.2 years) and 223 455 adolescents and adults aged 12 years and older (mean age, 41.6 years).

Findings

Analysis of pre- and post-exacerbation medication patterns found that the cumulative proportions of patients who filled prescriptions for a SABA and for a maintenance medication increased as an exacerbation event got closer.

The researchers reported that within 30 days prior to the serious exacerbation, the cumulative proportion of patients with one or more SABA fills was 42.6%; the corresponding proportion for a maintenance medication fill was 57.4%, which meant 42.6% of patients did not claim a maintenance medication in the 30 days before an exacerbation.

Overall, 52.1% of these patients with a SABA fill filed those claims during the 10 days before the event. Among those who filled a SABA claim within 30 days post-event, most did so within the first 10 days afterward.

Authors' comment

"Although current treatment paradigms in the United States are predominantly based on the daily use of anti-inflammatory maintenance medication in combination with rescue SABA, real-world claims patterns identified in this study indicate that this treatment paradigm does not sufficiently treat the increase in inflammation preceding an exacerbation."

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