Many Commercially Insured Patients With Asthma Have Uncontrolled Disease

Researchers found that nearly 39% of commercially insured patients in the United States with asthma, regardless of disease severity, do not have good control of their disease.

The results were shared in a poster presented at the American Academy of Allergy Asthma & Immunology 2021 Annual Meeting and exposed the extent of uncontrolled asthma in the US population covered by commercial insurance.

Uncontrolled asthma often leads to worse health outcomes and increased risk of exacerbations for patients, the poster’s authors noted. They based their analysis on 2018 Global Initiative for Asthma (GINA) guideline classifications for asthma management and good symptom control.

Guideline-defined assessment of disease control for asthma is based on symptom burden and exacerbation risk. However, because asthma control is regularly underestimated by patients and health care professionals, and due to several other limitations, it is difficult to measure in patient populations.

Systemic corticosteroids (SCSs) and short-acting beta-agonists (SABAs) are common medications given to patients with asthma to aid in symptom relief and resolve exacerbations. Use of these agents is highly reported in patients with severe asthma, with frequent prescriptions fills a possible indication of high symptoms burden and poor disease control.

The investigators conducted a retrospective analysis using data from the IBM/Watson MarketScan US claims database. Their study population included 579,955 patients aged 12 or older who had prescriptions filled for SCSs or SABAs between January 2016 and December 2017 and who received an asthma diagnosis within the 12 months before or the 3 months after the date of their first filled prescription.

The patients were classified into 1 of 5 disease severity groups based on the 2018 GINA guidance, with GINA 5 indicating the most severe conditions. The breakdown in disease severity for this study population was:

• GINA 1: 54.3%
• GINA 2: 14.6%
• GINA 3: 10.2%
• GINA 4: 19.8%
• GINA 5: 1.1%

Overall, the results showed that 38.7% of all patients had uncontrolled asthma regardless of GINA classification.

Additionally, uncontrolled asthma was observed in more than 25% of patients from each GINA category when uncontrolled was defined as receiving 2 or more annual SCS fills and/or 3 or more SABA fills. Uncontrolled asthma was observed in 29% of GINA 1 patients, 42% of GINA 2 patients, 46% of GINA 3 patients, 58% of GINA 4 patients, and 76% of GINA 5 patients.

A stricter definition of uncontrolled asthma, in which patients received 3 or more SCS fills and/or 4 or more SABA fills, yielded smaller yet sizable results, with 14% of GINA 1 patients, 24% of GINA 2 patients, 27% of GINA 3 patients, 39% of GINA 4 patients, and 60% of GINA 5 patients fitting the criteria.

“These clinically meaningful proportions of uncontrolled asthma highlight the need for improved strategies for asthma management,” wrote the investigators.

They noted that their patient population may be representative of the wider insured US population, but that more studies are needed to assess the proportion of uncontrolled asthma in the noncommercially-insured population.

Although updates to the GINA guidelines contained recent consensus, scientific information, and therapies, the researchers argued that newer paradigms shed light on the benefits for achieving SCS-free control as a target of asthma remission.

“By changing the standard goal from disease control to disease remission, strategies may evolve and lead to an advancement in treatment,” said the researchers.

Reference

Mychaskiw MA, Lim S, Colilla S, Brown R. Assessing asthma control by frequency of systemic corticosteroid and/or short‐acting beta‐agonist prescriptions in us administrative claims data. Presented at: American Academy of Allergy Asthma & Immunology 2021 Annual Meeting; February 26-March 1, 2021; Poster 132.