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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
  1. Joan Sweeney1,
  2. Chris C Patterson2,
  3. Andrew Menzies-Gow3,
  4. Rob M Niven4,
  5. Adel H Mansur5,
  6. Christine Bucknall6,
  7. Rekha Chaudhuri7,
  8. David Price8,
  9. Chris E Brightling9,
  10. Liam G Heaney1
  11. on behalf of the British Thoracic Society Difficult Asthma Network
  1. 1Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK
  2. 2Centre for Public Health, Queen's University of Belfast, Belfast, UK
  3. 3Royal Brompton Hospital, London, UK
  4. 4MAHSC, The University of Manchester & UHSM, Manchester, UK
  5. 5Severe and Brittle Asthma Unit, Birmingham Heartlands Hospital, Birmingham, UK
  6. 6Department of Respiratory Medicine, Royal Infirmary, Glasgow, UK
  7. 7Division of Immunology, Infection and Inflammation, Department of Respiratory Medicine, University of Glasgow and Gartnavel General, Glasgow, UK
  8. 8Academic Primary Care, University of Aberdeen, Aberdeen, UK
  9. 9Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, UK
  1. Correspondence to Professor Liam G Heaney, Centre for Infection and Immunity, Queen's University of Belfast, Wellcome-Wolfson Institute for Experimental Medicine, 97 Lisburn Road, Belfast BT9 7BL, UK; jsweeney13{at}qub.ac.uk

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.

  • Asthma
  • Drug reactions

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