Pharmacological treatment of asthma in Sweden from 2005 to 2015

Figures & data

Figure 1. Flow chart over inclusion of patients. Randomly included patients without overlap between cohorts.

Table 1. Characteristics of the study participants in 2005 and 2015 (n (%)).

	2005	2015	p Value
	n = 1182	n = 1225
Sex			0.65
Women	708 (59.9%)	745 (60.8%)
Men	474 (40.1%)	480 (39.2%)
Age (years)			<0.001
≤39	316 (26.9%)	252 (20.6%)
40─54	329 (28.1%)	322 (26.3%)
55─64	299 (25.5%)	249 (20.3%)
≥65	229 (19.5%)	402 (32.8%)
Smoking history			<0.001
Never	621 (52.7%)	687 (56.7%)
Former	353 (30.0%)	393 (32.4%)
Current	204 (17.3%)	132 (10.9%)
Education			<0.001
Shorter	661 (57.5%)	574 (47.5%)
Longer	489 (42.5%)	635 (52.5%)
Body mass index			0.03
<25	466 (39.9%)	428 (36.7%)
≥25─<30	450 (38.5%)	431 (37.0%)
≥30	253 (21.6%)	306 (26.3%)
Level of care			0.74
Primary care	842 (71.2%)	865 (70.6%)
Secondary care	340 (28.8%)	360 (29.4%)

Variables with significant differences are written in bold.

Table 2. Pharmacological asthma treatment in 2005 compared to 2015 (n (%)).

	2005	2015	p Value
	n = 1182	n = 1225
Step 1a No maintenance treatment	277 (23.4%)	269 (22.0%)	0.39
Step 1b Periodic treatment with inhaled corticosteroids	264 (22.3%)	255 (20.8%)	0.37
Step 2 Regular treatment with inhaled corticosteroids only	178 (15.1%)	159 (13.0%)	0.14
Step 3 Regular treatment with inhaled corticosteroids in combination with LABA and/or montelukast	463 (39.2%)	542 (44.2%)	0.012
Regular treatment with ICS in any combination	641 (54.2 %)	701 (57.2 %)	0.14
Regular treatment with ICS + LABA	458 (38.7 %)	529 (43.2 %)	0.027
Regular montelukast treatment	90 (7.6%)	105 (8.6%)	0.39
Regular treatment with oral corticosteroids	34 (2.9%)	62 (5.1%)	0.007
Course of oral corticosteroids due to asthma exacerbation at any time during the past 6 months (patients taking oral corticosteroids regularly excluded)			0.44
No	931 (81.5%)	956 (82.3%)
Once	106 (9.3%)	91 (7.8%)
Twice	49 (4.3%)	61 (5.3%)
More than twice	56 (4.9%)	53 (4.6%)
SABA more than twice during the previous week	543 (46.4%)	508 (41.8%)	0.023
Extra doses of LABA more than twice during the previous week	158 (13.5%)	125 (10.6%)	0.029
Extra doses of ICS + LABA more than twice during the previous week	129 (11.1%)	229 (18.9%)	<0.001
Overall use of symptom reliever more than twice during the previous week	600 (51.2%)	595 (49.4%)	0.39

Variables with significant differences are written in bold.

Figure 2. Prevalence (%) of treatment on step 1–3 within each age group (years (n)) in 2015.

Step 1a: No maintenance treatment. Step 1b: Periodic treatment with inhaled corticosteroids.

Step 2: Regular treatment with inhaled corticosteroids only. Step 3: Regular treatment with inhaled corticosteroids in combination with LABA and/or montelukast.

Table 3. Asthma treatment 2015 in patients on different treatment steps.

Asthma treatment step	Step 1a^1 (n = 269)	Step 1b^2 (n = 255)	Step 2^3 (n = 159)	Step 3^4 (n = 542)	p Value	OR (95% CI)
Symptom control assessed by ACT					<0.001
Well controlled (ACT ≥20)	200 (81.6%)	142 (59.4%)	82 (53.6%)	253 (48.8%)		1
Poorly controlled (ACT <20)	45 (18.4%)	97 (40.6%)	71 (46.4%)	265 (51.2%)		2.13 (1.63−2.77)*
Exacerbation past 6 months					<0.001
No	248 (92.2%)	192 (75.6%)	122 (76.7%)	346 (63.8%)		1
Yes	21 (7.8%)	62 (24.4%)	37 (23.3%)	196 (36.2%)		2.76 (2.07−3.68)^†
Sex					0.95
Female	162 (60.2%)	159 (62.4%)	97 (61.0%)	327 (60.3%)		1
Male	107 (39.8%)	96 (37.6%)	62 (39.0%)	215 (39.7%)		1.08 (0.83−1.40)*
Age (years)					<0.001
≤39	78 (29.0%)	74 (29.0%)	30 (18.9%)	70 (12.9%)		1
40─54	81 (30.1%)	76 (29.8%)	42 (26.4%)	123 (22.7%)		1.67 (1.12−2.48)*
55─64	48 (17.8%)	38 (14.9%)	29 (18.2%)	134 (24.7%)		3.11 (2.01−4.80)*
≥65	62 (23.0%)	67 (26.3%)	58 (36.5%)	215 (39.7%)		3.36 (2.21−5.10)*
Smoking history					0.003
Never	154 (57.9%)	163 (65.2%)	92 (59.0%)	278 (51.5%)		1
Former	78 (29.3%)	59 (23.6%)	50 (32.1%)	206 (38.1%)		1.35 (1.01−1.81)*
Current	34 (12.8%)	28 (11.2%)	14 (9.0%)	56 (10.4%)		0.95 (0.62−1.47)*
Education					0.001
Shorter	111 (41.9%)	98 (39.4%)	85 (53.5%)	280 (52.2%)		1
Longer	154 (58.1%)	151 (60.6%)	74 (46.5%)	256 (47.8%)		1.08 (0.81−1.43)*
Body mass index					0.82
<25	99 (39.1%)	90 (37.3%)	57 (38.3%)	182 (34.9%)		1
≥25─<30	86 (34.0%)	90 (37.3%)	58 (38.9%)	197 (37.7%)		0.93 (0.68−1.25)*
≥30	68 (26.9%)	61 (25.3%)	34 (22.8%)	143 (27.4%)		0.91 (0.65−1.27)*
Physical activity					0.23
Less than once a week	80 (30.2%)	58 (23.8%)	46 (30.5%)	126 (23.8%)		1
1─3 times/week	128 (48.3%)	136 (55.7%)	79 (52.3%)	279 (52.7%)		1.20 (0.88−1.64)*
At least 4 times/week	57 (21.5%)	50 (20.5%)	26 (17.2%)	124 (23.4%)		1.39 (0.95−2.03)*
Allergic asthma					0.016
No	85 (31.7%)	52 (20.5%)	34 (21.5%)	133 (24.6%)		1
Yes	183 (68.3%)	202 (79.5%)	124 (78.5%)	408 (75.4%)		1.08 (0.80−1.46)*

To the left divided by patients’ basic characteristics (n (%), p value within group for chi²-test) and to the right adjusted odds ratios for maintenance treatment on step 3, compared to treatment on any other step (OR (95% CI)*. Variables with significant differences are written in bold.

*Adjusted for the other variables in the table, except for exacerbations.

^†Adjusted for the other variables in the table, except for ACT.

¹No maintenance treatment. ²Periodic treatment with inhaled corticosteroids. ³Regular treatment with inhaled corticosteroids only. ⁴Regular treatment with inhaled corticosteroids in combination with LABA and/or montelukast.

Figure 3. Prevalence (%) of daily use of SABA within each treatment step (n) in 2015.

Step 1a: No maintenance treatment. Step 1b: Periodic treatment with inhaled corticosteroids.

Step 2: Regular treatment with inhaled corticosteroids only. Step 3: Regular treatment with inhaled corticosteroids in combination with LABA and/or montelukast.

Table 4. Daily SABA use in 2015 (n (%), p value within group for chi² test) and adjusted odds ratio (OR (95% CI))*.

	No daily SABA use	Daily SABA use		OR (95% CI)*
	(n = 900)	(n = 264)
Sex			0.50
Female	545 (60.6%)	166 (62.9%)		1
Male	355 (39.4%)	98 (37.1%)		0.86 (0.63−1.17)*
Age (years)			<0.001
≤39	204 (22.7%)	34 (12.9%)		1
40─54	250 (27.8%)	59 (22.3%)		0.97 (0.58−1.61)*
55─64	170 (18.9%)	68 (25.8%)		1.64 (0.97−2.77)*
≥65	276 (30.7%)	103 (39.0%)		1.78 (1.07−2.96)*
Smoking history			0.002
Never	523 (58.6%)	132 (50.6%)		1
Former	288 (32.3%)	86 (33.0%)		0.87 (0.62−1.23)*
Current	82 (9.2%)	43 (16.5%)		1.71 (1.08−2.71)*
Education			<0.001
Shorter	378 (42.3%)	166 (63.8%)		1
Longer	516 (57.7%)	94 (36.2%)		0.52 (0.37−0.72)*
Body mass index			0.012
<25	329 (38.2%)	79 (31.5%)		1
≥25─<30	323 (37.5%)	88 (35.1%)		1.11 (0.77−1.61)*
≥30	210 (24.4%)	84 (33.5%)		1.53 (1.04−2.24)*
Physical activity			0.001
Less than once a week	216 (24.6%)	79 (31.1%)		1.59 (1.11−2.27)*
1─3 times/ week	490 (55.8%)	108 (42.5%)		1
At least 4 times/week	172 (19.6%)	67 (26.4%)		1.81 (1.25−2.64)*
Allergic asthma			0.019
No	238 (26.5%)	51 (19.4%)		1
Yes	659 (73.5%)	212 (80.6%)		1.71 (1.18−2.47)*
Exacerbation past 6 months			<0.001
No	712 (79.1%)	153 (58.0%)		1
Yes	188 (20.9%)	111 (42.0%)		2.71 (1.97-3.72)^†

Variables with significant differences are written in bold.

*Adjusted for the other variables in the table, except for exacerbations.

^†Adjusted for the other variables in the table.