P144 Regional variation in OCS use for UK patients with asthma: heat map analysis. (12th November 2019)

• Record Type: Journal Article
• Authors: Menzies-Gow, A; Haslam, T; Morris, T; Gylvin, LH; Bleecker, ER; Nan, C
• Is Part Of: Thorax. Volume 74(2019)Supplement 2
• Page Start: A169
• Page End: A169
• Publication Date: 2019-11-12
• Subjects: Chest -- Diseases -- Periodicals; Thorax; Chest -- Diseases; Periodicals; Periodicals; 617.54
• DOI: 10.1136/thorax-2019-BTSabstracts2019.287
• Languages: English
• ISSNs: 0040-6376

Abstract

Abstract : Introduction and objectives: A better understanding of differences in asthma prevalence between regions will inform disease management and treatment. To examine regional variations in prevalence of severe asthma and severe, uncontrolled asthma, we analyzed pharmacy records from the United Kingdom. Methods: Data for 4, 356, 990 patients who received treatment for fixed airflow obstruction during 2018 were extracted from IQVIA's longitudinal database of UK pharmacy records, which included data for 61% of all UK patients from 46% of pharmacies. Indications for prescriptions were not available. Therefore, patients aged <35 years were classified as having asthma by default. Those aged ≥35 years were classified based on predominant monthly therapy consistent with asthma treatment. Patients were excluded if age was unknown, or they may have had intermittent asthma (≤3 prescriptions during 2018). Patients who received a daily average ≥80% of high-dosage inhaled corticosteroid (ICS) therapy during the year were considered to have had severe asthma. Severe asthma was considered uncontrolled if patients also received ≥1 oral corticosteroid prescription. Results: We identified >3 million patients with asthma. Severe asthma prevalence was approximately 25% overall and was greatest in the southwest and east of England and in parts of Wales (figure). Prevalence of severe asthma was comparatively less for greater London and other metropolitan areas. Prevalence of severe, uncontrolled asthma was greatest for Northern Ireland. Pharmacy migration, nonadherence to medication, and inability to link patients across pharmacies may have resulted in the underestimation of prescriptions, particularly in urban areas where populations are more likely to be transient. However, a sensitivity analysis that included only patients with 100% ICS coverage (adherent and nontransient) did not reveal any large differences in relative prevalences from the primary analysis. Conclusions: Regional patterns of severe asthma and severe, uncontrolled asthma were notably different. For some regions, relatively high prevalence might be explained by small patient numbers. Patients may have received high ICS dosages rather than biologic therapies, based on local access restrictions. Despite data limitations, this first heat map analysis of unmet needs for UK patients with severe asthma provides important tools for the discussion on improving severe asthma care.