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Patterns of Inhaled Asthma Medication Use^*

A 3-Year Longitudinal Analysis of Prescription Claims Data From British Columbia, Canada

^* From the Department of Health Care and Epidemiology (Drs. Lynd and Anis), University of British Columbia, Vancouver, BC, Canada; and the Centre for Health Evaluation and Outcome (Ms. Guh) and the iCAPTURE Centre (Dr. Paré), Providence Health Care, Vancouver, BC, Canada.

Correspondence to: Aslam H. Anis, PhD, Center for Health Evaluation and Outcome Sciences, 620-1081 Burrard St, Vancouver, BC, Canada V6Z 1Y6; e-mail: anis{at}cheos.ubc.ca

Study objectives: To assess trends in asthma management and to identify factors associated with increasing short-acting (SA) ß-agonist utilization in British Columbia using administrative prescription data.

Design: A retrospective cohort analysis.

Setting: All patients between 13 and 50 years of age who had received at least one prescription for a SA ß-agonist covered by BC Pharmacare between January 1, 1996, and December 31, 1998.

Methods: Cross-sectional analysis of all patients, and longitudinal analyses only of patients who had received at least one SA ß-agonist prescription in each of the 3 years. Trends in asthma medication use over time were evaluated using repeated-measures Mantel-Haenszel tests. Multiple logistic regression was used to identify factors associated with increasing SA ß-agonist use.

Results: A total of 78,758 patients were included in the cohort. No decrease in the annual prevalence of receiving more than four canisters per year of a SA ß-agonist was identified between 1996 and 1998. A total of 12,844 patients filled at least one SA ß-agonist prescription each year. Time-trend analysis showed an overall increasing probability of not receiving an inhaled corticosteroid (ICS) agent in this population (p = 0.002). In patients exhibiting low SA ß-agonist use, > 18 years of age (adjusted odds ratio [OR], 1.5), male gender (adjusted OR, 1.7), and in receipt of social assistance (adjusted OR, 2.3) were associated with receiving increasing amounts of SA ß-agonist agents over the 3 years. In patients with a high degree of use of SA ß-agonists, only the receipt of social assistance (adjusted OR, 1.3) was significantly associated with increasing use.

Conclusions: Despite the development and dissemination of asthma management guidelines, there was no trend toward decreasing SA ß-agonist use. An unexpected trend toward decreasing ICS utilization was identified. Receiving social assistance was a risk factor for increasing SA ß-agonist use, independent of baseline utilization.

Key Words: adrenal cortex hormones • adrenergic ß-agonists • asthma • drug therapy • pharmacoepidemiology

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				L. D. Lynd, A. J. Sandford, E. M. Kelly, P. D. Pare, T. R. Bai, J. M. FitzGerald, and A. H. Anis Reconcilable Differences: A Cross-sectional Study of the Relationship Between Socioeconomic Status and the Magnitude of Short-Acting {beta}-Agonist Use in Asthma Chest, October 1, 2004; 126(4): 1161 - 1168. [Abstract] [Full Text] [PDF]