Dynamics of inhaled corticosteroid use are associated with asthma attacks

Abstract Inhaled corticosteroids (ICS) suppress eosinophilic airway inflammation in asthma, but patients may not adhere to prescribed use. Mean adherence—averaging total doses taken over prescribed—fails to capture many aspects of adherence. Patients with difficult-to-treat asthma underwent electron...

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Autores principales:	Joy Lee, Jacqueline Huvanandana, Juliet M. Foster, Helen K. Reddel, Michael J. Abramson, Cindy Thamrin, Mark Hew
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/3c709a4e9f674b2fb72fb3d8350c5c95
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spelling	oai:doaj.org-article:3c709a4e9f674b2fb72fb3d8350c5c952021-12-02T16:17:22ZDynamics of inhaled corticosteroid use are associated with asthma attacks10.1038/s41598-021-94219-z2045-2322https://doaj.org/article/3c709a4e9f674b2fb72fb3d8350c5c952021-07-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-94219-zhttps://doaj.org/toc/2045-2322Abstract Inhaled corticosteroids (ICS) suppress eosinophilic airway inflammation in asthma, but patients may not adhere to prescribed use. Mean adherence—averaging total doses taken over prescribed—fails to capture many aspects of adherence. Patients with difficult-to-treat asthma underwent electronic monitoring of ICS, with data collected over 50 days. These were used to calculate entropy (H) a measure of irregular inhaler use over this period, defined in terms of transitional probabilities between different levels of adherence, further partitioned into increasing (Hinc) or decreasing (Hdec) adherence. Mean adherence, time between actuations (Gapmax), and cumulative time- and dose-based variability (area-under-the-curve) were measured. Associations between adherence metrics and 6-month asthma status and attacks were assessed. Only H and Hdec were associated with poor baseline status and 6-month outcomes: H and Hdec correlated negatively with baseline quality of life (H:Spearman rS = − 0·330, p = 0·019, Hdec:rS = − 0·385, p = 0·006) and symptom control (H:rS = − 0·288, p = 0·041, Hdec: rS = − 0·351, p = 0·012). H was associated with subsequent asthma attacks requiring hospitalisation (Wilcoxon Z-statistic = − 2.34, p = 0·019), and Hdec with subsequent asthma attacks of other severities. Significant associations were maintained in multivariable analyses, except when adjusted for blood eosinophils. Entropy analysis may provide insight into adherence behavior, and guide assessment and improvement of adherence in uncontrolled asthma.Joy LeeJacqueline HuvanandanaJuliet M. FosterHelen K. ReddelMichael J. AbramsonCindy ThamrinMark HewNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Joy Lee Jacqueline Huvanandana Juliet M. Foster Helen K. Reddel Michael J. Abramson Cindy Thamrin Mark Hew Dynamics of inhaled corticosteroid use are associated with asthma attacks
description	Abstract Inhaled corticosteroids (ICS) suppress eosinophilic airway inflammation in asthma, but patients may not adhere to prescribed use. Mean adherence—averaging total doses taken over prescribed—fails to capture many aspects of adherence. Patients with difficult-to-treat asthma underwent electronic monitoring of ICS, with data collected over 50 days. These were used to calculate entropy (H) a measure of irregular inhaler use over this period, defined in terms of transitional probabilities between different levels of adherence, further partitioned into increasing (Hinc) or decreasing (Hdec) adherence. Mean adherence, time between actuations (Gapmax), and cumulative time- and dose-based variability (area-under-the-curve) were measured. Associations between adherence metrics and 6-month asthma status and attacks were assessed. Only H and Hdec were associated with poor baseline status and 6-month outcomes: H and Hdec correlated negatively with baseline quality of life (H:Spearman rS = − 0·330, p = 0·019, Hdec:rS = − 0·385, p = 0·006) and symptom control (H:rS = − 0·288, p = 0·041, Hdec: rS = − 0·351, p = 0·012). H was associated with subsequent asthma attacks requiring hospitalisation (Wilcoxon Z-statistic = − 2.34, p = 0·019), and Hdec with subsequent asthma attacks of other severities. Significant associations were maintained in multivariable analyses, except when adjusted for blood eosinophils. Entropy analysis may provide insight into adherence behavior, and guide assessment and improvement of adherence in uncontrolled asthma.
format	article
author	Joy Lee Jacqueline Huvanandana Juliet M. Foster Helen K. Reddel Michael J. Abramson Cindy Thamrin Mark Hew
author_facet	Joy Lee Jacqueline Huvanandana Juliet M. Foster Helen K. Reddel Michael J. Abramson Cindy Thamrin Mark Hew
author_sort	Joy Lee
title	Dynamics of inhaled corticosteroid use are associated with asthma attacks
title_short	Dynamics of inhaled corticosteroid use are associated with asthma attacks
title_full	Dynamics of inhaled corticosteroid use are associated with asthma attacks
title_fullStr	Dynamics of inhaled corticosteroid use are associated with asthma attacks
title_full_unstemmed	Dynamics of inhaled corticosteroid use are associated with asthma attacks
title_sort	dynamics of inhaled corticosteroid use are associated with asthma attacks
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/3c709a4e9f674b2fb72fb3d8350c5c95
work_keys_str_mv	AT joylee dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT jacquelinehuvanandana dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT julietmfoster dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT helenkreddel dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT michaeljabramson dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT cindythamrin dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks AT markhew dynamicsofinhaledcorticosteroiduseareassociatedwithasthmaattacks
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Dynamics of inhaled corticosteroid use are associated with asthma attacks

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