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The Clinical Course of Asthma After Withdrawal of Inhaled Corticosteroids

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Abstract
BACKGROUND: Maintenance of inhaled corticosteroids (ICSs) is recommended in adults with asthma. However, adherence rates in patients with mild asthma and side effects of long-term ICS use can lead to withdrawal.

OBJECTIVE: To analyze the real-world outcomes of ICS withdrawal by analyzing data from the Korean National Health Insurance database.

METHODS: Based on claims data from the National Health Insurance of Korea between 2011 and 2014, we identified patients diagnosed with asthma without chronic obstructive pulmonary disease or long-term systemic steroid use who had an ICS medication possession rate of more than 50% in a year. We compared patients who received ICS consistently (maintenance group) with patients who had no ICS prescription for more than 6 months (withdrawal group). We evaluated exacerbation leading to prescription of systemic steroid and emergency department visit or hospitalization.

RESULTS: Excluding patients with chronic obstructive pulmonary disease and long-term systemic steroid users, we identified 145,511 patients for the asthma cohort (mean age, 60.0 years; ever-smoker, 63.5%): 132,175 maintained ICS and 13,336 withdrew ICS for more than 6 months. Only 71 patients (0.5%) experienced exacerbation leading to an emergency department visit or hospitalization in the withdrawal group. ICS was restarted within 1 year for 33.6% of the withdrawal group, and 90% of these patients restarted ICS within 158 days.

CONCLUSIONS: This nationwide study of patients with asthma, characterized by a high proportion of elderly and smokers, showed that ICS withdrawal in about 10% of patients appeared to confer relatively minimal harm and exacerbation leading to hospitalization was not common. Further prospective studies are warranted to carefully explore the safety of ICS withdrawal in younger, nonsmoking, and wellcontrolled patients with asthma. (C) 2020 American Academy of Allergy, Asthma Immunology
Author(s)
김화정오연목이상도이세원이재승Dong-Woo Han
Issued Date
2021
Type
Article
Keyword
Acute exacerbationAsthmaChronic obstructive pulmonary diseaseCodesCorticoidsDiseaseHealth insuranceHospitalizationHospitalsInhaled corticosteroidLung diseasesObstructive lung diseasePatients
DOI
10.1016/j.jaip.2020.09.056
URI
https://oak.ulsan.ac.kr/handle/2021.oak/7009
https://ulsan-primo.hosted.exlibrisgroup.com/primo-explore/fulldisplay?docid=TN_cdi_proquest_miscellaneous_2451131770&context=PC&vid=ULSAN&lang=ko_KR&search_scope=default_scope&adaptor=primo_central_multiple_fe&tab=default_tab&query=any,contains,The%20Clinical%20Course%20of%20Asthma%20After%20Withdrawal%20of%20Inhaled%20Corticosteroids&offset=0&pcAvailability=true
Publisher
JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE
Location
미국
Language
영어
ISSN
2213-2198
Citation Volume
9
Citation Number
3
Citation Start Page
1295
Citation End Page
1295
Appears in Collections:
Medicine > Medicine
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