ICS do not decrease exacerbations in Asthmatics with Eosinophilia
Adherence to inhaled corticosteroid (ICS) treatment is not associated with a decreased occurrence of exacerbations in asthma patients with elevated blood eosinophil levels, according to a study published in Journal of Allergy and Clinical Immunology.
Patients with asthma and elevated blood eosinophils are at increased risk of severe exacerbations. Management of these patients should consider nonadherence to inhaled corticosteroid (ICS) therapy as a factor for increased exacerbation risk.
Exacerbation may refer to an increase in the severity of a disease or its signs and symptoms
Alberto Papi conducted a study to investigate whether poor adherence to ICS therapy explains the occurrence of asthma exacerbations in patients with elevated blood eosinophil levels.
The authors utilized the Optimum Patient Care Research Database to identify patients ≥18 years old who were classified as steps 3 or 4 according to the Global Initiative for Asthma with ≥2 ICS prescriptions in the year prior to clinical review. The study authors explained that patient characteristics and adherence (based on prescription refills and patient self-report) for ICS therapy were analyzed for those with elevated (>400 cells/μL) or normal (≤400 cells/μL) blood eosinophils.
Of the total of 7195 patients included in the study, 66% were female and their average age was 60 years. The median eosinophil count of the patients was 200 cells/mL and 81% of the patients were not fully adherent to ICS therapy.
Of the 1031 patients (14%) with elevated blood eosinophil counts, 83% were found not to be fully adherent to ICS therapy. It was also reported that, among patients with elevated eosinophil levels, a larger proportion who were adherent to therapy experienced ≥2 exacerbations (14.0% vs 7.2%) and uncontrolled asthma (73% vs 60.8%) compared with those who were not fully adherent to therapy.
The study concluded that approximately 1 in 7 patients had elevated eosinophils and adherence to ICS therapy was not associated with decreased exacerbations for these patients. Additional therapy such as biologics, which have been previously shown to improve control in severe uncontrolled eosinophilic asthma should be considered for these patients.
For more reference log on tohttps://doi.org/10.1016/j.jaip.2018.03.008