Imperial College London
Alternate

Dr Laure de Preux

Business School

Assistant Professor
 
 
 
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Contact

 

+44 (0)20 7594 9349l.depreux

 
 
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Location

 

486City and Guilds BuildingSouth Kensington Campus

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Summary

 

Publications

Citation

BibTex format

@article{Bloom:2020:10.1371/journal.pmed.1003145,
author = {Bloom, C and de, Preux L and Sheikh, A and Quint, J},
doi = {10.1371/journal.pmed.1003145},
journal = {PLoS Medicine},
title = {Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: a population-based observational study},
url = {http://dx.doi.org/10.1371/journal.pmed.1003145},
volume = {17},
year = {2020}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - BackgroundGuidelines recommend stepping down asthma treatment to the minimum effective dose to achieve symptom control, prevent adverse side effects, and reduce costs. Limited data exist on asthma prescription patterns in a real-world setting. We aimed to evaluate the appropriateness of doses prescribed to a UK general asthma population and assess whether stepping down medication increased exacerbations or reliever use, as well as its impact on costs.Methods and findingsWe used nationwide UK primary care medical records, 2001–2017, to identify 508,459 adult asthma patients managed with preventer medication. Prescriptions of higher-level medication: medium/high-dose inhaled corticosteroids (ICSs) or ICSs + add-on medication (long-acting β2-agonist [LABA], leukotriene receptor antagonist [LTRA], theophylline, or long-acting muscarinic antagonist [LAMA]) steadily increased over time (2001 = 49.8%, 2017 = 68.3%). Of those prescribed their first preventer, one-third were prescribed a higher-level medication, of whom half had no reliever prescription or exacerbation in the year prior. Of patients first prescribed ICSs + 1 add-on, 70.4% remained on the same medication during a mean follow-up of 6.6 years. Of those prescribed medium/high-dose ICSs as their first preventer, 13.0% already had documented diabetes, cataracts, glaucoma, or osteopenia/osteoporosis. A cohort of 125,341 patients were drawn to assess the impact of stepping down medication: mean age 50.4 years, 39.4% males, 39,881 stepped down. Exposed patients were stepped down by dropping their LABAs or another add-on or by halving their ICS dose (halving their mean-daily dose or their inhaler dose). The primary and secondary outcomes were, respectively, exacerbations and an increase in reliever prescriptions. Multivariable regression was used to assess outcomes and determine the prognostic factors for initiating stepdown. There was no increased exacerbation risk for each possible medication stepdown (ad
AU  - Bloom,C
AU  - de,Preux L
AU  - Sheikh,A
AU  - Quint,J
DO  - 10.1371/journal.pmed.1003145
PY  - 2020///
SN  - 1549-1277
TI  - Health and cost impact of stepping down asthma medication for UK patients, 2001–2017: a population-based observational study
T2  - PLoS Medicine
UR  - http://dx.doi.org/10.1371/journal.pmed.1003145
UR  - http://hdl.handle.net/10044/1/80920
VL  - 17
ER  -
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