Asthma and lower airway diseaseThe prevalence of severe refractory asthma
Section snippets
Design
In this descriptive observational study we used a definition of severe refractory asthma based on recent international consensus criteria5 and estimated the prevalence of severe refractory asthma. In short, automated dispensing records from 65 community pharmacies in The Netherlands were used to identify all patients with at least 1 prescription for an inhaled corticosteroid (ICS) in 2011. In The Netherlands around 90% of the population obtains their medication from only 1 community pharmacy,
Results
Responders and nonresponders to the questionnaire did not differ with respect to OCS prescriptions (median of 0.99 mg [interquartile range, 0.57-2.3 mg] prednisone equivalent for nonresponders and 0.99 mg [interquartile range, 0.57-2.2 mg] for responders, P = .09). Adherence to ICSs was significantly lower in nonresponders (mean ± SD, 80% ± 56%) than in responders (mean ± SD, 84% ± 50%; P < .05).
Fig 2 shows that of 500,500 subjects included in the pharmacy database, 382,883 (76.5%) were adults.
Discussion
This study shows that 17.4% of the total asthmatic population had difficult-to-control asthma, which was defined as uncontrolled asthma despite the prescription of high-intensity asthma treatment. However, only 20.5% of these patients were adherent to their high-dose ICS prescription and had a correct inhalation technique, corresponding with only 3.6% of the total asthmatic population. This suggests that the prevalence of severe refractory asthma, as defined by international consensus, might be
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Supported by Novartis Pharma B.V.
Disclosure of potential conflict of interest: This study was funded by Novartis. M. L. Bouvy's institution has received funding from the SIR Institute for Pharmacy Practice and Policy. E. H. Bel has received compensation for board membership from Novartis, as well as consultancy fees from GlaxoSmithKline, Regeneron, and CIPLA and has received or has grants pending from Chiesi and GlaxoSmithKline, from which she has also received payment for delivering lectures. The rest of the authors declare that they have no relevant conflicts of interest.