Patterns of Rescue and Maintenance Medication Claims Surrounding an Asthma Exacerbation in Patients Treated as Intermittent or Mild Persistent Asthma

Purpose: To examine patterns of short-acting ß₂-agonist (SABA) and maintenance therapy claims surrounding the subset of severe asthma exacerbations associated with outpatient, urgent care, or emergency department visits or hospitalization (termed serious exacerbations) in patients treated as intermittent or mild persistent asthma.
Methods: This was a retrospective study of 2010– 2017 administrative claims from Merative^TM MarketScan^® US databases for patients ≥ 12 years filling a SABA prescription for asthma (index). Patients had ≥ 12 months continuous insurance eligibility pre- and post-index and ≥ 1 additional SABA and/or maintenance medication fill appropriate for mild persistent asthma post-index. Prescription fills were assessed over 30 days before and after a serious exacerbation event.
Results: Of 323,443 patients (mean [standard deviation] age: 34.9 [18.2] years; 62.0% female) treated as intermittent or mild persistent asthma, 51,690 (16.0%) experienced ≥ 1 serious exacerbation post-index. During the 30 days pre-event, a greater proportion of patients filled a SABA versus maintenance therapy (24.6% vs 19.0%; odds ratio [OR]: 1.39, 95% confidence interval [CI]: 1.35– 1.43; p < 0.001); during the 30 days post-event, patients were more likely to fill maintenance medication versus SABA (88.6% vs 67.0%; OR [95% CI]: 3.88 [3.75– 4.01]; p < 0.001). The closer in time prior to the event, the greater the likelihood of filling a SABA versus maintenance prescription (OR [95% CI]; 1– 7 days pre-event: 1.42 [1.36– 1.48]; 8– 14 days pre-event: 1.34 [1.27– 1.41]; 15– 30 days pre-event: 1.18 [1.12– 1.24]; all p < 0.001). Over 4.5 times more patients filled a maintenance therapy within 7 days post-event (45,014) versus all 30 days pre-event (9835) (OR [95% CI]: 28.7 [27.7– 29.7]; p < 0.001).
Conclusion: These patterns of SABA rescue and maintenance fills suggest that a “window of opportunity” may exist to interrupt a serious exacerbation occurrence for patients treated as intermittent or mild persistent asthma if symptoms and inflammation are addressed concomitantly.

Keywords: asthma, corticosteroid, inflammation, maintenance therapy, rescue therapy, short-acting ß₂-agonist