Continuity of prescribing with inhaled corticosteroids and control of asthma

Purpose - Current asthma guidelines advocate early intervention with inhale d corticosteroids. The aim of the study was to examine the association betw een continuity of dispensed prescribing for inhaled corticosteroids, and ho spitalization for asthma or use of high dose oral corticosteroids. Methods - Using the MEMO record-linkage database we identified subjects rec eiving inhaled corticosteroids (aged 12-45 years). Compliance was estimated by calculating the number of days, for which a subject could have taken an inhaled corticosteroid. In the 90-day exposure-window, subjects with 90 da ys therapy were considered to be 'compliant', those with 1-89 days to be 'p artially compliant', and those with zero days to be 'non-compliant'. Results - There were 4535 subjects who had 88 occurrences of hospitalizatio n for asthma, and 457 subjects with either hospitalization or high dose ora l corticosteroids. The proportion of hospitalizations for compliant, partia lly compliant and noncompliant subjects was 9, 3 and 1%. The odds-ratios, v ersus compliance, were 0.34 (95% CI, 0.19-0.62) for partial compliance, and 0.10 (95% CI, 0.05, 0.19) for non-compliance. This association disappeared after adjustment for beta-agonists and other relief medication. Conclusions - As dispensed prescribing decreased, the incidence of hospital ization and high dose oral corticosteroids decreased. Patients with good co ntinuity of prescribing had the highest rates of serious asthma-related out comes. Copyright (C) 2000 John Wiley & Sons, Ltd.