Initial maintenance therapy adherence among older adults with asthma-COPD overlap

• Published in: The American journal of managed care 2021-11, Vol.27 (11), p.463-470
• Main Author: Nili, Mona
• Format: Article
• Language: English
• Subjects: Asthma; Beneficiaries; Chronic obstructive pulmonary disease; Drug dosages; Health administration; Health maintenance organizations; HMOs; Medicare; Older people; Patient compliance; Steroids; Variables
• ISSN: 1088-0224; 1936-2692
• DOI: 10.37765/ajmc.2021.88773

The adjusted odds of persistent low adherence to IMT were 62% less among those taking fixed-dose combinations of inhaled corticosteroids and long-acting β agonists (ICS/LABAs) compared with inhaled corticosteroid (ICS) monotherapy. * Poor adherence to IMT is very common among older adults with ACO. * Group-based trajectory modeling identified 4 trajectories of medication adherence to IMT among individuals with ACO. * Using ICS/LABAs for IMT may decrease the likelihood of persistent low adherence over time among older adults with ACO compared with ICS monotherapy. _____ Many older adults have coexisting asthma and chronic obstructive pulmonary disease (COPD), known as asthma-COPD overlap (ACO).1 Treatment for ACO requires treating both the underlying asthma and COPD by using maintenance therapy with inhaled medications.2 In 2017, the joint guidelines of the Global Initiative for Asthma (GINA) and Global Initiative for Chronic Obstructive Lung Disease recommended an inhaled corticosteroid (ICS) with or without a long-acting β agonist (LABA) for initial maintenance therapy (IMT) in individuals with ACO.2 Another important supporting reason for considering ICS/LABA as the preferable IMT option for ACO relates to the recent changes in the GINA guideline for asthma. Since 2019, a fixed-dose combination of ICS and formoterol, a LABA compound, is recommended as the first-line treatment for asthma.3 By considering the similarity of treatment approaches of asthma and ACO, it is possible to extend this recommendation for ACO as well. Among patients with asthma or COPD, poor adherence to maintenance therapy is associated with increased risk of adverse events such as hospitalization, disease burden, and mortality.17-19 Therefore, older individuals with ACO may also experience these negative consequences, perhaps to an even greater degree. [...]the objectives of this study were to identify adherence trajectories of IMT and to assess the impact of IMT type on adherence trajectories among older adults with ACO by using group-based trajectory modeling (GBTM). METHODS Data Source This study used health insurance claims from a 10% sample of Optum's Clinformatics Data Mart from January 1, 2007, through June 30, 2017. Selection of covariates was guided by the Anderson health behavior model.23 Per the framework, adherence to IMT may be affected by (1) predisposing variables (sex [male or female]; age); (2) enabling factors (insurance plan [health maintenance organization (HMO)