Patterns of Rescue and Maintenance Therapy Claims Surrounding a Clinical Encounter for an Asthma Exacerbation

Determine how maintenance and rescue therapies are used in the days leading up to and after asthma exacerbations.US patients contained in the Merative MarketScan Commercial, Medicare Supplemental, and Multistate Medicaid Research Databases greater than or equal to 4 years old with moderate to severe asthma.This was an observational, retrospective cohort study of 319,342 patients with moderate to severe asthma. 30% were children aged 4 to 11 years-old, and 70% were adolescents and adults aged 12 + years-old. Asthma exacerbations were defined as “severe” when prescriptions were filled for systemic steroids. These exacerbations became “serious” when there was a face-to-face provider involved. The primary outcome was medication fills for both short-acting beta-agonists (SABA) and maintenance medications (MM) in the 30-day window before and after the occurrence of a serious exacerbation (SE).Of participants, 51.5% had a severe exacerbation, whereas 19.9% had a SE. In the 30 days leading up to a SE, 42.6% of patients filled a SABA and 57.4% filled a MM. Children had higher fill rates before a SE than their older counterparts. Fill rates for MM (94.8%) were greater than SABA (61.4%) after exacerbations. The odds of filling a SABA in the 10 days after versus 10 days before a SE was 8.04 for children and 4.73 for adults. The odds of filling a MM in the 10 days after versus 10 days before a SE was 102.17 for children and 20.68 for adults. Despite this, 30.6% of patients experienced multiple exacerbations within the next year.Many asthmatics and their caregivers do not fill prescriptions for therapies leading up to exacerbations. Our strategy appears to be reactive as opposed to proactive and does not translate to future stability. Despite high fill rates after exacerbations, many asthmatics have exacerbations within the next year.Although fill data does not ensure use of medications, this study demonstrates that there is a window of opportunity to step up therapy. It is crucial that pediatricians equip patients with a proactive approach to asthma care and confirm parental understanding of indications for these MM by discussing how therapy can reduce airway inflammation, the need for oral steroids, and hospitalizations.