Impact of aging on high-dose inhaled corticosteroid use and specialist care management in patients with asthma: a Danish nationwide cohort study.

OBJECTIVE

Asthma is a common chronic respiratory disease affecting people of all ages, but little is known about age-related differences in treatment strategies. The present study aims to explore age-related differences in inhaled corticosteroid (ICS) use and place of asthma management.

METHODS

All Danish adults with a registered secondary care asthma diagnosis or active treatment (>1 redemption of ICS within 365 days) in 2021 were included. Individuals with chronic obstructive pulmonary disease and individuals who migrated or died during the observation period were excluded. Danish national registries provided all treatment data.

RESULTS

A total of 184,565 patients with asthma (median age 57 [IQR 43-69], 59% female) were included. Overall, 15.7% of the asthma population was treated with high (>800-1600 budesonide-equivalent ug/day) or supratherapeutic (>1600 budesonide-equivalent ug/day) doses of ICS, and the proportion increased with age before reaching a plateau from age 56 onwards (lowest: 18-45 years, 9.7%; highest: 66-75 years, 18.9%; p < .001). Significantly fewer of the patients in the oldest age group were seen in specialist care (highest: 56-65 years, 18.9%; lowest: >86 years, 11.4%; p < .001), and 77.3% of patients exposed to high or supratherapeutic doses of ICS were managed only in primary care.

CONCLUSION

The prevalence of high- and supratherapeutic ICS exposure was higher among patients ≥56 years, and when exceeding 76 years of age, a smaller proportion were managed in secondary care. With an increased focus on adverse effects of high-dose ICS treatment and earlier initiation of other treatments, our findings will, hopefully, facilitate less age inequity in asthma management.