title: Burden of Chronic Oral Corticosteroid Use by Adults with Persistent Asthma.
abstract: BACKGROUND
  Chronic oral corticosteroid (C-OCS) use in asthma is an indicator of disease severity, but its risk factors are largely unknown.
  
  
  OBJECTIVE
  To describe patient characteristics and disease burden associated with C-OCS use by adults with persistent asthma.
  
  
  METHODS
  We identified 9546 patients aged 18 to 64 years in a large managed care organization who met the Healthcare Effectiveness Data and Information Set 2-year criteria (2009-2010) for persistent asthma. A subgroup had blood eosinophil counts. We calculated cumulative OCS dispensed per patient in 2010 and examined the distribution of disease characteristics by average daily amounts of OCS dispensed. C-OCS use was defined as 2.5 mg/d or more. Baseline factors (2010) associated with C-OCS use during follow-up (2011) were investigated by multivariable Poisson regression.
  
  
  RESULTS
  At baseline, 782 (8.2%) patients were C-OCS users. Compared with patients who received no or less than 2.5 mg/d OCS, C-OCS users were older and more often female and ethnic minorities; and had more comorbidities, asthma specialist care, greater step-care level, controllers, asthma exacerbations, and greater blood eosinophil counts (all P < .01). Baseline factors significantly associated with C-OCS use in the follow-up year included (1) demographic characteristics: older age, females, blacks versus whites, and whites versus others/unknown ethnicities; (2) disease burden: more asthma emergency department or hospitalization visits, greater step-care level, excessive short-acting β2-agonist dispensed, theophylline use, asthma specialist care, and nasal polyposis; (3) greater blood eosinophil counts; and (4) most strongly, C-OCS use.
  
  
  CONCLUSIONS
  C-OCS use was associated with more asthma burden, comorbidities, and greater blood eosinophil counts. Prior C-OCS use was the strongest predictor of future C-OCS use.
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif. Electronic address: robert.s.zeiger@kp.org.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Zeiger
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Qiaowu
authors.initials: Q
authors.lastname: Li
authors.affiliation: Departments of Allergy and Research and Evaluation, Kaiser Permanente Southern California, San Diego and Pasadena, Calif.
authors.forename: Wansu
authors.initials: W
authors.lastname: Chen
authors.affiliation: Statistical Sciences, MedImmune LLC, Gaithersburg, Md.
authors.forename: Deepak B
authors.initials: DB
authors.lastname: Khatry
authors.affiliation: Observational Research Center, AstraZeneca, Gaithersburg, Md.
authors.forename: Trung N
authors.initials: TN
authors.lastname: Tran
mesh_terms: D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use*; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000627:therapeutic use*; D001249:Asthma / Q000097:blood / Q000188:drug therapy* / Q000453:epidemiology; D015897:Comorbidity; D004363:Drug Utilization; D004636:Emergency Service, Hospital; D004804:Eosinophils; D005260:Female; D006760:Hospitalization; D006801:Humans; D007958:Leukocyte Count; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D018927:Anti-Asthmatic Agents
keywords: Administrative data; Allergist; Asthma control; Asthma guidelines; Asthma specialist; Blood eosinophil count; Chronic oral corticosteroid use; Comorbidities; Controller medication; Corticosteroid; Exacerbations; Managed care; Persistent asthma; Short-acting β(2)-agonists