Corresponding author:
Inge Raadal Skov
Department of Respiratory Medicine
Odense University Hospital
J. B. Winsløws Vej 4
5000 Odense C, Denmark
E-mail:
inge.raadal.skov@rsyd.dk
Fax: +45 66 12 43 05
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Abstract
Background : Oral corticosteroid use in asthma management can lead
to serious adverse effects, but knowledge on usage trends are limited.
We aimed to investigate this in a nationwide asthma cohort in Denmark
from 1999-2018.
Methods : By use of Danish nationwide registers, we identified all
young adults (18-45 years) with two or more asthma drug collections
within 12 months since the age of 15 as indicative of active asthma.
Oral corticosteroid use was stratified by exposure level as high use (≥5
mg prednisolone/day) and low use (<5 mg/day) per year, age
groups and gender. Lorenz curves were used to express the skewness of
consumption among users.
Results : We identified 318,950 unique individuals with active
asthma during the study period with a median age of 29 years
(interquartile range [IQR] 20-38 years) whereof 57% were women. The
1-year prevalence of oral corticosteroid users was stable at 4.8%
(median, IQR 4.7%-4.8%), but with a nearly 40% decrease in high-users
from 0.54% in 1999 to 0.33% in 2018. The median annual dose decreased
from 500 mg/y in 1999 to 250 mg/y in 2018. We found a substantial
skewness in the distribution of oral corticosteroid usage with 10% of
users accounting for almost 50% of all oral corticosteroid use.
Conclusions : Although the prevalence of oral corticosteroid users
among young adults with active asthma in Denmark has been relatively
stable from 1999-2018, we observed a decreasing trend in the prevalence
of high-users and annual consumption.
Word count : Abstract 239 words
Introduction
Asthma is the most common respiratory disease among children and adults,
estimated to affect over 339 million people globally (1). It is
characterized by considerable heterogeneity in both severity degrees and
inflammation types (2, 3). Corticosteroids have constituted the
cornerstone in asthma treatment since the 1950s due to the potent and
wide-ranging anti-inflammatory effects (4). Though oral corticosteroids
(OCS) were largely replaced by inhaled corticosteroids (ICS) during the
1970-80s, OCS still remain crucial in asthma management guidelines today
as short-term treatment for asthma exacerbations or as last choice
opportunity in long-term treatment for severe asthma (5, 6).
Unfortunately, OCS use is associated with numerus adverse effects
involving cardiovascular, musculoskeletal, and endocrine systems (7).
While the adverse effects of long-term OCS are well recognized in asthma
treatment guidelines (5), a growing amount of evidence indicate that
also repeated short-term OCS use can lead to serious adverse effects due
to the cumulative exposure (8-10). This risk increases at cumulative
doses as low as 1 g of prednisolone corresponding to 4 lifetime courses
(9, 11), which calls for an overall increased attention on appropriate
OCS use in asthma treatment (12-14). Although the management of severe
asthma has advanced with the access to biologic therapies, these
treatments are costly and reserved to selected patients, i.e. patients
with severe asthma and a high degree of type 2 inflammation (15).
Consequently, frequent or long-term OCS use remain prevalent in many
cases of severe or uncontrolled asthma (10).
The monitoring of OCS usage trends is crucial in order to better address
and prevent OCS-related adverse effects, as well as to evaluate
potential treatment changes at the arrival of biologic treatments. We
therefore aimed to explore nationwide and longitudinal utilization
trends of OCS among young adults with asthma in Denmark during a 20-year
period, which has not previously
been done.