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.
  
  
  METHODS
  Cross-sectional observational study.
  
  
  METHODS
  The primary care Optimum Patient Care Research Database and the British Thoracic Society Difficult Asthma Registry.
  
  
  METHODS
  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).
  
  
  METHODS
  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.
authors.affiliation: Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK.
authors.forename: Joan
authors.initials: J
authors.lastname: Sweeney
authors.affiliation: Centre for Public Health, Queen's University of Belfast, Belfast, UK.
authors.forename: Chris C
authors.initials: CC
authors.lastname: Patterson
authors.affiliation: Royal Brompton Hospital, London, UK.
authors.forename: Andrew
authors.initials: A
authors.lastname: Menzies-Gow
authors.affiliation: MAHSC, The University of Manchester & UHSM, Manchester, UK.
authors.forename: Rob M
authors.initials: RM
authors.lastname: Niven
authors.affiliation: Severe and Brittle Asthma Unit, Birmingham Heartlands Hospital, Birmingham, UK.
authors.forename: Adel H
authors.initials: AH
authors.lastname: Mansur
authors.affiliation: Department of Respiratory Medicine, Royal Infirmary, Glasgow, UK.
authors.forename: Christine
authors.initials: C
authors.lastname: Bucknall
authors.affiliation: Division of Immunology, Infection and Inflammation, Department of Respiratory Medicine, University of Glasgow and Gartnavel General, Glasgow, UK.
authors.forename: Rekha
authors.initials: R
authors.lastname: Chaudhuri
authors.affiliation: Academic Primary Care, University of Aberdeen, Aberdeen, UK.
authors.forename: David
authors.initials: D
authors.lastname: Price
authors.affiliation: Department of Infection, Inflammation and Immunity, Institute for Lung Health, University of Leicester, Leicester, UK.
authors.forename: Chris E
authors.initials: CE
authors.lastname: Brightling
authors.affiliation: Centre for Infection and Immunity, Queen's University of Belfast, Belfast, UK.
authors.forename: Liam G
authors.initials: LG
authors.lastname: Heaney
mesh_terms: D000284:Administration, Oral; D000328:Adult; D000368:Aged; D001249:Asthma / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015992:Body Mass Index; D002386:Cataract / Q000139:chemically induced; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000139:chemically induced* / Q000453:epidemiology; D004381:Duodenal Ulcer / Q000139:chemically induced; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000139:chemically induced* / Q000453:epidemiology; D010024:Osteoporosis / Q000139:chemically induced* / Q000453:epidemiology; D015995:Prevalence; D011788:Quality of Life; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D017678:Sex Distribution; D020181:Sleep Apnea, Obstructive / Q000139:chemically induced; D013276:Stomach Ulcer / Q000139:chemically induced; D006113:United Kingdom / Q000453:epidemiology
chemical_list: D005938:Glucocorticoids
keywords: Asthma; Drug reactions