No Improvement of Asthma Control Despite Changes in Pharmacological Treatment Patterns – 17 Years Follow Up

Caroline Ahlroth Pind,1,2 Björn Ställberg,3 Karin Lisspers,3 Josefin Sundh,4 Marta A Kisiel,5 Hanna Sandelowsky,6,7 Anna Nager,6 Mikael Hasselgren,8,9 Scott Montgomery,10– 12 Maaike Giezeman,8,9 Gabriella Eliason,4 Christer Janson2 1Centre for Clinical Research Västmanland, Uppsala University, VästerÃ¥s, Sweden; 2Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University, Uppsala, Sweden; 3Department of Public Health and Caring Sciences, General Practice, Uppsala University, Uppsala, Sweden; 4Department of Respiratory Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 5Department of Medical Sciences, Occupational and Environmental Medicine, Uppsala University, Uppsala, Sweden; 6NVS, Division of Family Medicine and Primary Care, Karolinska Institutet, Stockholm, Sweden; 7Academic Primary Care Centre, Region Stockholm, Stockholm, Sweden; 8Centre for Clinical Research and Education Region Värmland, Karlstad, Sweden; 9School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 10Clinical Epidemiology Division, Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; 11Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; 12Department of Epidemiology and Public Health, University College London, London, UKCorrespondence: Caroline Ahlroth Pind, Department of Medical Sciences, Respiratory, Allergy and Sleep Research, Uppsala University Hospital, Entrance 40, Uppsala, 751 85, Sweden, Tel +46738059703, Email [email protected]: Asthma control is reported to be low, often based on cross-sectional studies. There have been only a few longitudinal studies following asthma patients. We have assessed asthma control and asthma treatment over 17 years in a cohort of asthma patients.Methods: Patients, 18– 75 years, with doctor-diagnosed asthma were randomly selected from healthcare units in Sweden. They answered questionnaires about symptoms and pharmacological treatment in 2005, 2012, and 2022. This study includes participants completing the last follow-up (n=437). Optimal asthma control was defined as no nocturnal asthma symptoms, use of short-acting β 2-agonist twice or less in the past week, and no exacerbations in the last six months.Results: There was no difference in frequency of optimal asthma control (41.8% vs 40.5%, p=0.68). Inhaled corticosteroids (ICS) in combination with long-acting β 2-agonists increased from 2005 to 2022 as regular maintenance treatment (40.3% vs 46.7%, p=0.009) and as reliever medicine (11.6% vs 18.9%, p< 0.001). The overall use of reliever medicine more than twice in the past week did not change (48.3% vs 51.6%, p=0.24). The overall use of ICS decreased (78.0% vs 70.4%, p< 0.001), as did the occurrence of having a written action plan (21.9% vs 10.4%, p< 0.001). Optimal asthma control and lack of written action plans were related to discontinuation of ICS treatment.Conclusion: Non-optimal asthma control is common long after diagnosis. Discontinuation of ICS may sometimes be due to optimal asthma control and no need for treatment, but lack of written action plans increases the risk of inappropriate discontinuation.Keywords: inhaled corticosteroids, short-acting β 2-agonist, written action plan