Medication management, health outcomes, and economic burden of severe asthma stratified by asthma control levels.

BACKGROUND

Severe asthma-a critical subset of asthma-is known for escalating the risk of asthma-related symptoms. However, current research on the management and burden of severe asthma in developing countries remains limited, especially in China, constraining evidence-based policymaking.

OBJECTIVES

This study aims to evaluate the medication management, health outcomes, and economic burden of severe asthma across different control levels in China.

METHODS

We analyzed routinely collected data on nearly 1.7 million subjects from Tianjin, China. Severe asthma was identified based on specific medication use patterns. Patients were stratified as uncontrolled, suboptimally controlled or controlled according to the inpatient admission, short-term systemic corticosteroid use and short-acting inhaled beta₂-agonist use. Over a one-year follow-up period, the medication management, health outcomes, and economic burden were assessed.

RESULTS

A total of 2418 patients with severe asthma were identified. Inhaled corticosteroids/long-acting beta2-agonist (ICS/LABA) was the most commonly used controller medication (93.51 %), while patients with poorer control spent more on additional controller medications and Chinese herbal medicines. Oral corticosteroids (OCS) were less used (10.75 %), but the mean daily dosage of OCS among OCS users was as high as 15.68 mg-1.6 times the recommended dosage in Chinese guidelines. Only 17.78 % of patients with severe asthma demonstrated good adherence (defined as proportion of days covered ≥ 0.8) to asthma control treatment. Patients with uncontrolled asthma showed a significantly high proportion of exacerbations (51.42 %) and incurred higher asthma-related medical cost than suboptimally controlled and controlled patients (CNY 8506.83 vs. 3559.35 vs. 2105.70, p = 0.000).

CONCLUSION

Patients with severe asthma exhibit poor treatment adherence, low OCS usage rates but excessively high doses among users, pursuit of alternative therapies, and a high economic burden in Tianjin, China. These findings underscore the urgent need to improve severe asthma management, particularly for those with uncontrolled asthma.