چکیده (انگلیسی):

Background:Inhaled corticosteroids (ICS) are the cornerstone of asthma therapy. The ICS-to-total-asthma-medication
ratios, calculated from claims data, indicate potentially risky disease management in asthma. Our aim was to assess the
utility of ICS-to-total-asthma-medication ratios from primary care electronic medical records (EMRs) in detecting patients
at risk of asthma exacerbation, as approached by prescription of oral corticosteroids and/or antibiotics.
Methods:Retrospective cohort studies were identified, using the Health Improvement Network general practice
database (THIN, United Kingdom) and the Cegedim Longitudinal Patient Data (France). We selected asthma patients
aged 16–40 years, with≥4 prescriptions for asthma medications in 2007 and≥1 prescription in 2008. For each
country, three groups were defined according to ratio value in 2008: 0% (non-ICS users), <50% (low-ICS-ratio group)
and≥50% (high-ICS-ratio group). Outcomes were marker of asthma exacerbations: systemic corticosteroids and
antibiotics. They were compared between groups in each country.
Results:Among 38,637 British and 4,587 French patients, higher numbers of prescriptions per patient of systemic
corticosteroids, antibiotics and total asthma medications were observed in the low-ICS-ratio groups compared to
other groups (p < 0.0001 for each outcome in both countries). Likewise, low-ICS-ratio patients had more medical
contacts (p < 0.0001 in both countries), suggesting poorly controlled asthma. ICS-treated patients had lower risks
of receiving systemic corticosteroids in 2008 in the high-ICS-ratio group, compared to the low-ICS-ratio group:
RR = 0.54, 95%CI = [0.50-0.57] and RR = 0.78, 95%CI = [0.67-0.91] in the UK and France, respectively.
Conclusions:Patients with high ICS-to-total-asthma-medication ratios presented fewer asthma-related outcomes.
The low ICS-to-total-asthma-medication ratio calculated with EMRs data reflects insufficient prescribing of ICS
relative to all asthma medications, whichmay lead to deteriorated asthma control