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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.

Sweeney, Joan and Patterson, Chris C and Menzies-Gow, Andrew and Niven, Rob M and Mansur, Adel H and Bucknall, Christine and Chaudhuri, Rekha and Price, David and Brightling, Chris E and Heaney, Liam G (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). pp. 339-46. ISSN 1468-3296. This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.

Full text not available from this repository.
Official URL: http://thorax.bmj.com/content/71/4/339.long

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.

Item Type: Article
Additional Information: This article is available to all HEFT staff and students via ASK HEFT Discovery tool www.heftlibrary.nhs.uk using their HEFT Athens Login.
Subjects: WF Respiratory system. Respiratory medicine
Divisions: Planned IP Care > Thoracic Surgery
Related URLs:
Depositing User: Mrs Yolande Brookes
Date Deposited: 16 Feb 2017 10:51
Last Modified: 16 Feb 2017 10:51
URI: http://www.repository.heartofengland.nhs.uk/id/eprint/1196

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