Characteristics of Oral Corticosteroid Users Among Persons with Asthma on GINA Step 3 Therapy and Above: A Cross-Sectional Study in Portuguese Community Pharmacies

Figures & data

Figure 1 Study flowchart.

Table 1 Characteristics of Adult Asthma Patients Receiving GINA Step 3 Therapy and Above, Overall and by History of OCS Use in the Previous 12 Months

	All n=347 (100%)	Non-OCS Users n=261	OCS Users n=86	p value
Female sex, n (%)	248 (71. 5%)	187 (71.6%)	61 (70.9%)	0.898
Age (years), average (SD)	59.5 (15.4)	60.5 (15.0)	56.3 (16.2)	0.049*
Age (years), n (%)
≤65 years	208 (59.9%)	149 (57.1%)	59 (68.6%)	0.059
>65 years	139 (40.1%)	112 (42.9%)	27 (31.4%)
BMI (kg/cm^2)†, average (SD)	28.0 (6.2)	28.1 (6.5)	27.7 (5.2)	0.797
Smoking status†, n (%)
Nonsmoker (never smoked)/ Second-hand smoker	217 (66.2%)	162 (65.6%)	55 (67.9%)	0.511
Ex-smoker	78 (23.8%)	62 (25.1%)	16 (19.8%)
Smoker	33 (10.0%)	23 (9.3%)	10 (12.3%)
Cigarettes/day, average (SD)
Smoker	9.7 (6.2)	11.1 (6.5)	6.4 (3.6)	0.048*
Ex-smoker	20.4 (17.2)	20.4 (17.3)	20.5 (17.2)	0.990
GINA step, n (%)
Step 3	1 (0.3%)	0 (0.0%)	1 (1.2%)	– ^¥
Step 4	166 (47.8%)	135 (51.7%)	31 (36.0%)
Step 5	180 (51.9%)	126 (48.3%)	54 (62.8%)
Self-reported adherence to ICS-LABA [If current user]‡, n (%)
“I use it every day”	307 (93.6%)	230 (93.1%)	77 (95.1%)	0.535
Other	21 (6.4%)	17 (6.9%)	4 (4.9%)
Comorbidities [YES]†, n (%)
Anxiety	162 (49.4%)	124 (50.2%)	38 (46.9%)	0.607
Rhinitis	154 (47.0%)	118 (47.8%)	36 (44.4%)	0.602
Hypertension	132 (40.2%)	102 (41.3%)	30 (37.0%)	0.498
Sinusitis	123 (37.5%)	91 (36.8%)	32 (39.5%)	0.668
Depression	70 (21.3%)	50 (20.2%)	20 (24.7%)	0.397
Conjunctivitis	58 (17.7%)	37 (15.0%)	21 (25.9%)	0.025*
Osteoporosis	54 (16.5%)	33 (13.4%)	21 (25.9%)	0.008*
Diabetes	52 (15.9%)	41 (16.6%)	11 (13.6%)	0.519
Sleep apnea	44 (13.4%)	33 (13.4%)	11 (13.6%)	0.960
Cataracts	44 (13.4%)	34 (13.8%)	10 (12.4%)	0.745
Gastrointestinal Disease	33 (10.1%)	20 (8.1%)	13 (16.1%)	0.039*
Arthritis	29 (8.8%)	17 (6.9%)	12 (14.6%)	0.029*
Glaucoma	18 (5.5%)	15 (6.1%)	3 (3.7%)	0.577
Other	8 (2.4%)	7 (2.8%)	1 (1.2%)	0.685

Notes: *Statistically significant (p<0.05); †Missing data=19; ‡Missing data=7 (current users=335); ^¥Chi-square test was not performed, since all regimens including long-term OCS treatment (maintenance treatment) are categorized as GINA step 5 by definition.

Table 2 Healthcare Resource Utilization and Measures of Asthma Control, Overall and by History of OCS Use in the Previous 12 Months

	All n=328† (100%)	Non-OCS Users n=247	OCS Users n=81	p value
Routine medical appointments, n (%)
Yes	194 (59.2%)	142 (57.5%)	52 (64.2%)	0.287
Number of routine medical appointments, average (SD)	1.4 (1.7)	1.3 (1.7)	1.5 (1.8)	0.147
Unscheduled consultations, n (%)
Yes	50 (15.2%)	23 (9.3%)	27 (33.3%)	<0.0001*
Number of unscheduled consultations‡, average (SD)	0.2 (0.7)	0.1 (0.5)	0.5 (0.9)	<0.0001*
Emergency department visits, n (%)
Yes	56 (17.1%)	30 (12.1%)	26 (32.1%)	<0.0001*
Number of emergency department visits, average (SD)	0.3 (0.8)	0.2 (0.6)	0.5 (1.0)	<0.0001*
[If ED visit] Hospital admissions (at least one night), n (%)
Yes	10 (17.9%)	6 (20.0%)	4 (15.4%)	0.737
Patients with urgent healthcare resource utilization (unscheduled consultations and/or ED visits), n (%)	87 (26.5%)	47 (19.0%)	40 (49.4%)	<0.0001*
Patients with no healthcare resource use (any kind), n (%)	99 (30.2%)	84 (34.0%)	15 (18.5%)	0.008*
CARAT score, average (SD)	19.4 (6.5)	20.3 (6.1)	16.8 (6.9)	<0.0001*

Notes: †The total n=328 corresponding to the patients that responded to the telephone interview; 19 patients did not complete the questionnaire. ‡Missing data=1; *Statistically significant (p<0.05).

Abbreviation: ED, emergency department.

Figure 2 Disease control (according to the CARAT®), overall and by history of OCS use in the previous 12 months. Statistically significant differences (*p<0.05) were found between OCS users and non-OCS users.

Figure 3 Patient characteristics significantly associated with the use of oral corticosteroids (p<0.05).

Table 3 Patient Characteristics Associated with OCS Use, According to the Exposure to OCS

	Low-Dose Users (<2.5mg Prednisolone/Day/Year) n=42 (100%)	High-Dose Users (≥2.5mg Prednisolone/Day/Year) n=23 (100%)
Age (years), n (%)
≤65 years	33 (78.6%)	11 (47.8%)
>65 years	9 (21.4%)	12 (52.2%)
Comorbidities [YES]†, n (%)
Conjunctivitis	9 (30.0%)	6 (35.3%)
Osteoporosis	6 (20.0%)	9 (52.9%)
Patients with urgent health care resources use (unscheduled consultations and/or ED visits)‡, n (%)	23 (57.5%)	10 (50.0%)
CARAT score, average (SD)‡	16.1 (7.2)	16.8 (7.1)

Notes: †Missing data=18; ‡Missing data=5.