title: The impact of poor asthma control among asthma patients treated with inhaled corticosteroids plus long-acting β2-agonists in the United Kingdom: a cross-sectional analysis.
abstract: There are several new treatment options for patients whose asthma remains uncontrolled on free-dose and fixed-dose combinations of inhaled corticosteroids plus long-acting β2-agonists (ICS+LABA). In order to evaluate the likely impact of these treatments, we assessed the effect of uncontrolled asthma on healthcare and patient burden within the UK among adult patients treated with ICS+LABA. Data obtained from 2010-2011 UK National Health and Wellness Surveys identified 701 patients treated with ICS+LABA. Patients with not well-controlled asthma (Asthma Control Test™ score <20) were compared with well-controlled asthma (score ≥ 20) patients on multiple measures. Cost burden was calculated using healthcare resource utilisation models and work productivity and impairment questionnaire. Overall, 452 and 249 patients reported not well-controlled and well-controlled asthma, respectively. A greater proportion of not well-controlled patients visited the accident & emergency department (21 vs. 14%, P = 0.016), were hospitalised (13 vs. 8%, P = 0.022) and had lower mental and physical health-related quality of life (P < 0.001) and impaired work productivity and activity scores: presenteeism (23 vs. 11%, P < 0.001), work impairment (29 vs. 17%, P < 0.001) and activity impairment (46 vs. 24%, P < 0.001). Calculated direct and indirect yearly costs/person doubled among not well-controlled compared to well-controlled asthma patients (£6592 vs. £3220). Total cost to society was estimated at £6172 million/year (direct costs, £1307 million; indirect costs, £4865 million). In conclusion, not well-controlled asthma is common among UK adults treated with ICS+LABA, resulting in impairments across a number of important health outcomes and represents a significant unmet need and resource burden.
  
  
  
  DRUG COMBO LEAVES MANY WITH UNCONTROLLED DISEASE: Many people who take inhaled steroids combined with long-acting β2-agonist drugs still have poorly controlled asthma. A team led by Ian Pavord from the University of Oxford, UK, identified 701 people from the 2010-2011 UK National Health and Wellness Surveys who were taking this drug combination for their asthma. The researchers found that nearly two-thirds of these individuals had poorly controlled asthma associated with more visits to the emergency room, worse quality of life (both mentally and physically), impaired productivity and other health problems. The calculated direct and indirect costs per person with poorly controlled asthma were about double that for someone whose asthma was under control. The authors conclude that better treatment and management is needed to reduce costs and address the unmet medical need for people with persistent uncontrolled asthma.
authors.affiliation: Respiratory Medicine Unit, Nuffield Department of Medicine, NDM Research Building, Old Road Campus, University of Oxford, Oxford, OX3 7FZ, UK. ian.pavord@ndm.ox.ac.uk.
authors.forename: Ian D
authors.initials: ID
authors.lastname: Pavord
authors.affiliation: Boehringer Ingelheim Limited, Ellesfield Avenue, Bracknell, Berkshire, RG12 8YS, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Mathieson
authors.affiliation: Boehringer Ingelheim Limited, Ellesfield Avenue, Bracknell, Berkshire, RG12 8YS, UK.
authors.forename: Anna
authors.initials: A
authors.lastname: Scowcroft
authors.affiliation: Kantar Health, Health Outcomes Practice, 19-31 Church Street, Epsom, Surrey, KT17 4PF, UK.|RTI Health Solutions, Avinguda Diagonal, 605, 9-1, Barcelona, 08028, Spain.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Pedersini
authors.affiliation: Kantar Health, Health Outcomes Practice, 19-31 Church Street, Epsom, Surrey, KT17 4PF, UK.
authors.forename: Gina
authors.initials: G
authors.lastname: Isherwood
authors.affiliation: Academic Primary Care, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen, AB25 2ZD, UK.
authors.forename: David
authors.identifier: http://orcid.org/0000-0002-9728-9992
authors.initials: D
authors.lastname: Price
mesh_terms: D000041:Absenteeism; D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D058666:Adrenergic beta-2 Receptor Agonists / Q000627:therapeutic use; D000328:Adult; D000368:Aged; D001249:Asthma / Q000188:drug therapy / Q000191:economics* / Q000503:physiopathology; D017281:Cost of Illness; D003430:Cross-Sectional Studies; D004359:Drug Therapy, Combination; D004526:Efficiency; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data; D005260:Female; D017048:Health Care Costs; D006304:Health Status; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D000069597:Presenteeism / Q000191:economics; D011788:Quality of Life; D006113:United Kingdom; D000066477:Work Performance / Q000191:economics; D055815:Young Adult
chemical_list: D000305:Adrenal Cortex Hormones; D058666:Adrenergic beta-2 Receptor Agonists