Pharmacological treatment of asthma in a cohort of adults during a 20-year period: results from the European Community Respiratory Health Survey I, II and III

Christer Janson, Simone Accordini, Lucia Cazzoletti, Isa Cerveri, Sebastien Chanoine, Angelo Corsico, Diogenes Seraphim Ferreira, Judith Garcia-Aymerich, David Gislason, Rune Nielsen, Ane Johannessen, Rain Jogi, Andrei Malinovschi, Jesús Martinez-Moratalla Rovira, Alessandro Marcon, Isabelle Pin, Jennifer Quint, Valerie Siroux, Enrique Almar, Valeria Bellisario, Karl A Franklin, José A Gullón, Mathias Holm, Joachim Heinrich, Dennis Nowak, José Luis Sánchez-Ramos, Joost J Weyler, Deborah Jarvis, Christer Janson, Simone Accordini, Lucia Cazzoletti, Isa Cerveri, Sebastien Chanoine, Angelo Corsico, Diogenes Seraphim Ferreira, Judith Garcia-Aymerich, David Gislason, Rune Nielsen, Ane Johannessen, Rain Jogi, Andrei Malinovschi, Jesús Martinez-Moratalla Rovira, Alessandro Marcon, Isabelle Pin, Jennifer Quint, Valerie Siroux, Enrique Almar, Valeria Bellisario, Karl A Franklin, José A Gullón, Mathias Holm, Joachim Heinrich, Dennis Nowak, José Luis Sánchez-Ramos, Joost J Weyler, Deborah Jarvis

Abstract

Asthma often remains uncontrolled, despite the fact that the pharmacological treatment has undergone large changes. We studied changes in the treatment of asthma over a 20-year period and identified factors associated with the regular use of inhaled corticosteroid (ICS) treatment. Changes in the use of medication were determined in 4617 randomly selected subjects, while changes in adults with persistent asthma were analysed in 369 participants. The study compares data from three surveys in 24 centres in 11 countries. The use of ICSs increased from 1.7% to 5.9% in the general population and the regular use of ICSs increased from 19% to 34% among persistent asthmatic subjects. The proportion of asthmatic subjects reporting asthma attacks in the last 12 months decreased, while the proportion that had seen a doctor in the last 12 months remained unchanged (42%). Subjects with asthma who had experienced attacks or had seen a doctor were more likely to use ICSs on a regular basis. Although ICS use has increased, only one-third of subjects with persistent asthma take ICSs on a regular basis. Less than half had seen a doctor during the last year. This indicates that underuse of ICSs and lack of regular healthcare contacts remains a problem in the management of asthma.

Conflict of interest statement

Conflict of interest: J.A. Gullón has nothing to disclose. Conflict of interest: R. Jogi reports receiving Estonian Research Council Personal Research Grant 562 during the conduct of the study; consultancy and lecture fees from GSK, Boehringer and Novartis, and travel, accommodation and meeting expenses from GSK and Boehringer. Conflict of interest: A. Johannessen has nothing to disclose. Conflict of interest: V. Bellisario has nothing to disclose. Conflict of interest: C. Janson reports receiving personal fees for lectures and advisory boards from AstraZeneca, Boehringer Ingelheim, Chiesi, Novartis and Teva, and for advisory boards from GSK, outside the submitted work. Conflict of interest: D. Jarvis reports receiving grants from Medical Research Council, during the conduct of the study. Conflict of interest: D. Gislason has nothing to disclose. Conflict of interest: I. Pin reports receiving travel grants from MSD, presentation fees from Teva, and both from AstraZeneca, outside the submitted work. Conflict of interest: J.L. Sánchez-Ramos has nothing to disclose. Conflict of interest: Isa Cerveri has nothing to disclose. Conflict of interest: S. Accordini has nothing to disclose. Conflict of interest: J.J. Weyler has nothing to disclose. Conflict of interest: R. Nielsen reports receiving grants from Boehringer Ingelheim and Novartis, personal fees from AstraZeneca, and grants and personal fees from GSK, outside the submitted work. Conflict of interest: L. Cazzoletti has nothing to disclose. Conflict of interest: J. Garcia-Aymerich has nothing to disclose. Conflict of interest: M. Holm has nothing to disclose. Conflict of interest: J. Martinez-Moratalla Rovira has nothing to disclose. Conflict of interest: V. Siroux reports receiving speakers’ honoraria from AstraZeneca, Novartis and Teva, outside the submitted work. Conflict of interest: A. Corsico has nothing to disclose. Conflict of interest: A. Marcon has nothing to disclose. Conflict of interest: S. Chanoine reports personal fees for board membership from AstraZeneca, and travel, accommodation and meeting expenses from Boehringer Ingelheim, Actelion Pharmaceuticals and MSD, outside the submitted work. Conflict of interest: J. Quint reports receiving grants from The Health Foundation, the MRC, the British Lung Foundation and IQVIA, grants and advisory board fees from GSK, Boehringer Ingelheim and AstraZeneca, travel fees from Chiesi and Teva, grants and speaking fees from Insmed, grants and consultancy fees from Bayer, outside the submitted work. Conflict of interest: D.S. Ferreira reports receiving grants from the Asthma Foundation of Victoria, Allen and Hanburys, and the National Health and Medical Research Council during the conduct of the study. Conflict of interest: D. Nowak has nothing to disclose. Conflict of interest: A. Malinovschi has nothing to disclose. Conflict of interest: K.A. Franklin has nothing to disclose. Conflict of interest: J. Heinrich has nothing to disclose.

Figures

FIGURE 1
FIGURE 1
Selection of population. ECRHS: European Community Respiratory Health Survey.
FIGURE 2
FIGURE 2
Change in the use of inhaled corticosteroids (as a single inhaler or in combination; any use in the last 12 months) in the random sample between European Community Respiratory Health Survey (ECRHS) I and III analysed by country and combined in a meta-analysis. Analysis was not possible for Estonia due to the limited number of participants. The area of each square is proportional to the reciprocal of the variance of the estimate for the country. The combined random effects estimate is shown by the dashed line; the width of the diamond is the 95% confidence interval.
FIGURE 3
FIGURE 3
Ecological analysis of the association between prevalence of current asthma and the use of mediation for asthma in each country: a) any asthma medication and b) inhaled corticosteroids.
FIGURE 4
FIGURE 4
Change in the regular use of inhaled corticosteroids (as a single inhaler or in combination; any use in the last 12 months) in participants with persistent asthma analysed by country and combined in a meta-analysis. Analysis was not possible for Estonia due to the limited number of participants. The area of each square is proportional to the reciprocal of the variance of the estimate for the country. The combined random effects estimate is shown by the dashed line; the width of the diamond is the 95% confidence interval.

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