Use of oral corticosteroids in asthma

Inge Raadal Skov

Research output: ThesisPh.D. thesis

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Abstract

Oral corticosteroids (OCS) are effective in treating uncontrolled inflammatory diseases such as asthma, but they are unfortunately associated with serious adverse effects. Many efforts have been
made to reduce the use of OCS in asthma over the decades, but international studies suggest OCS continue to be frequently used, and overused, in asthma management. However, limited information has been available on the OCS use among individuals with asthma in Denmark.


In this thesis we have conducted three nationwide, registry-based observational studies among cohorts of young adult users of asthma medication aged 18-45 years during 1999 to 2018.


In study I, we performed annual cross-sectional drug analyses and found that almost one in twenty among the annual asthma population would fill a prescription for OCS within a given year,
and that this had essentially not changed over the 20-year period. However, we found that the annual cumulative exposure per user decreased. High use ≥5 mg/day (prednisolone equivalents) was rare and decreased by almost 40%. Furthermore, the usage of low-dose tablets ≤10 mg/tablet decreased markedly, indicating a reduction in low-dose maintenance use. In study II, we performed a propensity score matched study of incident OCS users compared to nonusers. We found OCS users to have an increased risk of all prespecified comorbidities with evidence of positive dose-response relationships. Interestingly, the increased risks were evident at even low cumulative exposures of ≤500 mg (equivalent to only one or two OCS exacerbation courses). Mortality rates and rates of unscheduled hospital visits similarly increased with increasing OCS exposure. In study III, we investigated the
frequency and predictors of receiving specialist care among individuals with repeated OCS use (i.e., two prescriptions within 12 months). We found that 70% of repeated OCS users did not have contact to specialised care. However, the annual frequency of referrals for specialist care almost tripled from 6.3% in 1999 to 18% in 2018. Patients with excessive use of reliever medication and recent acute asthma-related hospital visits were more likely to receive specialist care.


In conclusion, the frequency of OCS use in asthma management of young adults has remained stable over a 20-year-period, but the cumulative exposure per person has decreased. OCS use is
associated with increased risk of incident comorbidities, mortality, and health care utilisation even at low cumulative doses. Only a minority of repeated OCS users are assessed by a specialist.
Considering recent advances in both diagnostic tools and available treatments, it is pivotal to ensure optimised management of patients exposed to OCS with focus on OCS sparing initiatives, managing of comorbidities, and early referral for specialist care when appropriate.

Original languageEnglish
Awarding Institution
  • University of Southern Denmark
Supervisors/Advisors
  • Davidsen, Jesper Rømhild, Principal supervisor
  • Madsen, Hanne, Supervisor
  • Henriksen, Daniel, Supervisor
Date of defence22. Jun 2022
Publisher
DOIs
Publication statusPublished - 20. May 2022

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