Pharmacological treatment of asthma in Sweden from 2005 to 2015

Abstract

Objective

Despite access to effective therapies many asthma patients still do not have well-controlled disease. This is possibly related to underuse of inhaled corticosteroids (ICS) and overuse of short-acting β2-agonists (SABA). Our aim was to investigate longitudinal trends and associated factors in asthma treatment.

Methods

Two separate cohorts of adults with physician-diagnosed asthma were randomly selected from 14 hospitals and 56 primary health centers in Sweden in 2005 (n = 1182) and 2015 (n = 1225). Information about symptoms, maintenance treatment, and use of rescue medication was collected by questionnaires. Associations between treatment and sex, age, smoking, education, body mass index (BMI), physical activity, allergic asthma, and symptom control were analyzed using Pearson’s chi²-test. Odds ratios (ORs) were calculated using logistic regression.

Results

Maintenance treatment with ICS together with long-acting β2-agonists (LABA) and/or montelukast increased from 39.2% to 44.2% (p = 0.012). The use of ICS + LABA as-needed increased (11.1–18.9%, p < 0.001), while SABA use decreased (46.4– 41.8%, p = 0.023). Regular treatment with ICS did not change notably (54.2–57.2%, p = 0.14). Older age, former smoking, and poor symptom control were related to treatment with ICS + LABA/montelukast. In 2015, 22.7% reported daily use of SABA. A higher step of maintenance treatment, older age, obesity, shorter education, current smoking, allergic asthma, low or very high physical activity, and a history of exacerbations were associated with daily SABA use.

Conclusions

The use of ICS + LABA both for maintenance treatment and symptom relief has increased over time. Despite this, the problem of low use of ICS and high use of SABA remains.

Keywords:

• Longitudinal study
• inhaled corticosteroids
• LABA
• long-acting β2-agonists
• SABA
• short-acting β2-agonists

Disclosure statement

Caroline Ahlroth Pind, Marta A Kisiel, Anna Nager and Mikael Hasselgren has no conflicts of interests to declare. Björn Ställberg has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, Chiesi, Meda, Novartis and Teva, and has served on advisory boards arranged by AstraZeneca, Novartis, Meda, GlaxoSmithKline, and Boehringer Ingelheim outside the submitted work. Karin Lisspers has received honoraria for educational activities from Boehringer Ingelheim, Novartis, AstraZeneca and Chiesi and served on advisory boards held by GlaxoSmithKline, Boehringer Ingelheim and AstraZeneca outside the submitted work. Josefin Sundh has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, Chiesi and Novartis outside the submitted work. Hanna Sandelowsky has received honoraria for educational activities from Boehringer Ingelheim, Novartis, AstraZeneca, Chiesi, and TEVA, and has served on advisory boards arranged by AstraZeneca, Novartis, Chiesi, and GlaxoSmithKline outside the submitted work. Scott Montgomery has received research grants and/or honoraria for advisory boards/lectures from Roche, Novartis, AstraZeneca, Teva, Merck and IQVIA outside the submitted work. Christer Janson has received honoraria for educational activities and lectures from AstraZeneca, Boehringer Ingelheim, GlaxoSmithKline, Orion, Novartis and Sanofi outside the submitted work.

Additional information

Funding

The study was financially supported by grants from the county councils of the Uppsala-Örebro Health Care region, the Swedish Heart and Lung Association, the Swedish Asthma and Allergy Association, the Bror Hjerpstedts Foundation, Swedish Heart-Lung Foundation, Uppsala Läns Förening mot Hjärt- och Lungsjukdomar and Praktikertjänst AB.