title: Level of Asthma Controller Therapy Before Admission to the Hospital.
abstract: In asthma, choice of controller therapy and adherence to treatment can affect the risk of future severe exacerbations leading to hospitalization.
  
  
  
  Our objective was to characterize treatment dispensation profiles before hospital admission for asthma.
  
  
  
  Using a 1/97th random sample of the national French claims data, patients with asthma aged 6 to 40 years were identified between 2006 and 2014. Patients with subsequent asthma-related hospitalization were selected. On the basis of controller therapy dispensed in the 12 months before admission, treatment profiles were categorized into clusters, using Ward's minimum-variance hierarchical clustering method.
  
  
  
  Of 17,846 patients with asthma, we identified 275 patients (1.5%) with an asthma-related hospitalization. Three distinct clusters were identified. The first cluster (63.6%) included patients with few dispensations of any controller medication (<1 unit). The second cluster (32.4%) consisted of patients with frequent dispensations of long-acting beta agonists (LABAs)/inhaled corticosteroids (ICS) in fixed-dose combinations. The third cluster (4%) comprised patients receiving free combinations of ICS and LABAs, with more dispensations of LABAs than of ICS.
  
  
  
  In France, before an asthma-related hospitalization, more than 60% of patients received little controller therapy and 4% were exposed to higher dispensation of LABAs than of ICS. These results indicate that a large fraction of asthma-related hospitalizations can potentially be prevented with better pharmacotherapy.
authors.affiliation: PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France. Electronic address: manon.belhassen@univ-lyon1.fr.
authors.forename: Manon
authors.initials: M
authors.lastname: Belhassen
authors.affiliation: PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France.
authors.forename: Carole
authors.initials: C
authors.lastname: Langlois
authors.affiliation: PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Laforest
authors.affiliation: Department of Communication Science, ASCoR, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Alexandra Lelia
authors.initials: AL
authors.lastname: Dima
authors.affiliation: PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Ginoux
authors.affiliation: Institute for Heart and Lung Health, Department of Medicine, The University of British Columbia, Vancouver, Canada; Centre for Clinical Epidemiology and Evaluation, The University of British Columbia, Vancouver, Canada.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Sadatsafavi
authors.affiliation: PELyon, Lyon, France; HESPER 7425, Health Services and Performance Research, Lyon, France; Respiratory Medicine, Croix Rousse University Hospital, Lyon, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Van Ganse
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D011307:Drug Prescriptions / Q000706:statistics & numerical data*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists; D018927:Anti-Asthmatic Agents
keywords: Asthma; Hospitalizations; Therapy; Treatment profiles