Use of oral corticosteroids in adults with asthma in Swedish primary care

<bold>Background:</bold> Asthma follow-up visits in primary care are infrequently performed and despite that oral corticosteroid (OCS) has substantial side effects, the use of OCS is still prevalent. <bold>Aim:</bold> To study the prevalence of OCS use in patients with asthma, and factors associated with discontinued OCS treatment following a health care visit. <bold>Method:</bold> Patients (≥18yr) with a primary healthcare visit in 2017-2019 (index-date), with a completed Asthma Control Test (ACT) were recruited from the Swedish National Airway Register. The database was linked to the Swedish Prescribed Drug Register to identify asthma treatment at index-date, and prescribed OCS ≥1 within 12 months pre- and post-index. <bold>Results:</bold> Of the 29760 patients identified, 7995 (27%) had OCS prescribed pre-index, and 5021 (17%) post-index (3011 both pre and post, 2010 only post). The distribution of OCS per GINA treatment step was (pre/post-index): <italic>step 1,</italic> 17/12%, <italic>step 2,</italic> 21/12%, <italic>step 3,</italic> 29/18%, <italic>step 4,</italic> 32/21% and <italic>step 5,</italic> 53/33%. Compared to patients using OCS both pre- and post-index (n=3011), those with OCS only pre-index (n=4984) were younger, had a lower BMI, higher FEV1% predicted, fewer comorbidities and a lower proportion had uncontrolled asthma. In adjusted analysis, younger age (OR 1.10, 95%CI 1.01-1.02), controlled asthma (1.41, 1.27-1.54), not having allergy (1.23, 1.12-1.37), rhinitis (1.37, 1.25-1.52) or cardiovascular disease (1.56, 1.41-1.72) were all associated with discontinued OCS treatment. Sex, BMI, diabetes, and depression were non-significant in the model. <bold>Conclusion:</bold> The result highlights the need for regular follow-up visits, supporting health care professionals to identify patients not in need of continued OCS treatment.