Inhaled Corticosteroids in Asthma and the Risk of Pneumonia.

PURPOSE: Asthma is a common disease that is expensive and burdensome for patients. Inhaled corticosteroids (ICS) are the most important drugs for asthma treatment and are often prescribed long-term. However, the use of ICS has been reported to increase pneumonia, though this remains controversial. We evaluated whether the use of ICS increases the risk of pneumonia in asthmatic patients using the Health Insurance Review and Assessment Service (HIRA) database in Korea. METHODS: The Asthma Management Adequacy Assessment was performed by the HIRA in Korea. Patients with claimed insurance benefits for asthma disease codes and who were prescribed asthma medications more than 2 times were enrolled. Patient demographics, asthma medications, healthcare use, and complications were analyzed. RESULTS: The total number of asthma patients was 831,613. Patients using ICS were older and had more comorbidities than those not using ICS; they also visited outpatient clinics and emergency departments, and were more often hospitalized. Pneumonia and other complications occurred more often in patients using ICS, and they used more respiratory medications, except for theophylline. Multiple logistic regression analysis showed that ICS prescription was associated with pneumonia (odds ratio, 1.38; 95% confidence interval, 1.36-1.41). Age, sex, medical care, use of secondary and tertiary hospitals, and hospitalization due to asthma in the previous year were also associated with pneumonia. CONCLUSIONS: ICS use was associated with increasing pneumonia in asthmatic patients in Korea. Therefore, it is critical to acknowledge that the use of ICS may increase the risk of pneumonia and should be meticulously monitored in asthmatics.

Nationwide use of inhaled corticosteroids by South Korean asthma patients: an examination of the Health Insurance Review and Service database.

BACKGROUND: Previous studies have found that the prescription rates of inhaled corticosteroid (ICS) were considerably low although it is recommended as the optimal asthma treatment. The aim of this study was to analyze the current status of ICS prescription for asthma patients in the South Korea. METHODS: We evaluated quality assessment data based on nationwide Health Insurance Review and Service (HIRA) database from July 2013 to June 2014. ICS prescription rates in asthma patients were analyzed by types and specialty of medical institutions. Also, we graded medical institutions by their ICS prescription rate. In addition, ICS prescription rates were calculated by patient gender, age, and insurance type. RESULTS: This study included 831,613 patients and 16,804 institutions in the analysis. The overall mean ICS prescription rate was 22.58%. Tertiary hospitals had the highest mean prescription rate (84.16%) whereas primary healthcare clinics had the lowest (20.71%). By specialty, internal medicine physicians prescribed ICS more frequently compared to other specialists. Of all, 47.17% of medical institutions prescribed ICS to <10% of asthma patients, while less than 6% of institutions prescribed ICS to >80% of asthma patients. Also, we found that female and patients with age >90 or <20 years exhibited lower ICS prescription rate. CONCLUSIONS: The ICS prescription rate was found to be inadequate, given the importance of ICS as an asthma treatment. The prescription rates were especially low in primary healthcare clinics, and by specialists in fields other than internal medicine.

Nationwide pulmonary function test rates in South Korean asthma patients.

BACKGROUND: Previous studies have shown that pulmonary function tests (PFTs) are performed at considerably lower rates than would be expected if standard guidelines were followed. The goal of this study was to evaluate the current status of PFT performance in the Republic of Korea. METHODS: We analysed quality assessment data from a nationwide Health Insurance Review and Assessment Service database collected from July 2013 to June 2014. PFT performance rates were compared among types and specialties of medical institutions. PFT performance rates were also measured by patient gender, age, and insurance type. Possession rates of PFT equipment and performance rates of each type of PFT were also evaluated. RESULTS: A total of 16,804 institutions and 831,613 patients were included in this study. The mean overall PFT performance rate was 22.67%. The performance rate in tertiary hospitals was 78.00%, while PFTs were performed in only 20.87% of asthma patients at primary health clinics. Male and elderly patients received PFTs more frequently than did female and younger patients. Also, patients who were covered by the Korean Veterans Health Service received a PFT more frequently than those covered by other insurance services. The possession rate of PFT equipment was significantly higher in tertiary hospitals than in primary health clinics. Of all PFT types, spirometry with flow-volume curve was performed for most patients. CONCLUSIONS: The PFT performance rate was significantly lower than would be expected if guidelines were followed. Average performance rates were higher in tertiary hospitals and for male and elderly patients.

Comparison of clinical characteristics and management of asthma by types of health care in South Korea.

BACKGROUND: Data on the clinical characteristics of asthma patients including utilization of medical facilities, disease management, and healthcare costs by types of health care are insufficient. METHODS: We evaluated data on 729,343 asthma patients from the Health Insurance Review and Assessment Service (HIRA) database of Korea between July 2013 and June 2014. RESULTS: Most asthma patients were treated via primary care (81.7%), followed by tertiary (17.8%) and secondary (0.5%) care. Patients requiring secondary or tertiary care exhibited more comorbidities and exacerbations than those treated via primary care, and utilized more medical facilities (associated with higher medical costs). The prescription rate of leukotriene receptor antagonists (LTRAs) was relatively high for those receiving all types of health care, ranging from 62% to 78%. However, the prescription rate of inhalants containing corticosteroids was significantly lower in patients treated via primary care than those receiving secondary or tertiary care (P<0.001). In addition, pulmonary function testing (PFT) was performed less often in patients treated via primary care than in those receiving secondary or tertiary care (P<0.001). CONCLUSIONS: Most patients with asthma were treated via primary care; however, those receiving secondary or tertiary care exhibited substantial utilization of medical facilities with high costs. Diagnostic measures and the prescription of inhalants containing corticosteroids in primary care require urgent attention.

Regular follow-up visits reduce the risk for asthma exacerbation requiring admission in Korean adults with asthma.

BACKGROUND: Asthma requires regular follow-up visits and sustained medication use. Although several studies have reported the importance of adherence to medication and compliance with the treatment, none to date have reported the importance of regular follow-up visits. We investigated the effects of regular clinical visits on asthma exacerbation. METHODS: We used claims data in the national medical insurance review system provided by the Health Insurance Review and Assessment Service of Korea. We included subjects aged ≥ 15 years with a diagnosis of asthma, and who were prescribed asthma-related medication, from July 2013 to June 2014. Regular visitors (frequent visitors) were defined as subjects who visited the hospital for follow-up of asthma three or more times per year. RESULTS: Among 729,343 subjects, 496,560 (68.1%) were classified as regular visitors. Old age, male sex, lack of medical aid insurance, attendance of a tertiary hospital, a high Charlson comorbidity index, and a history of admission for exacerbated asthma in the previous year were significant determining factors for regular visitor status. When we adjusted for all these factors, frequent visitors showed a lower risk of asthma exacerbation requiring general ward admission (odds ratio [OR] 0.48; 95% confidence interval [CI] 0.47-0.50; P < 0.001), emergency room admission (OR 0.83; 95% CI 0.79-0.86; P < 0.001), and intensive care unit admission (OR 0.49; 95% CI 0.44-0.54; P < 0.001) than infrequent visitors. CONCLUSIONS: Regular clinical visits are significantly associated with a reduced risk of asthma exacerbation requiring hospital admission in Korean adults with asthma.

Current status of asthma care in South Korea: nationwide the Health Insurance Review and Assessment Service database.

BACKGROUND: Quality control is important for patients with asthma because of its prevalence and because the social burden is substantial. This study analyzed the Health Insurance Review and Assessment Service (HIRA) database to assess asthma quality control in South Korea. METHODS: We investigated the HIRA nationwide database for reimbursed insurance claims from all medical institutions in South Korea from July 2013 to June 2014. The number of patients with asthma were evaluated and the medical institutions were categorized by type of medical institution. Asthma care quality was assessed by measuring the performance rate on pulmonary function test (PFT) and investigating prescriptions for asthma medications. RESULTS: A total of 16,804 medical institutions and 831,613 patients were included in this study. Among them, primary health clinics accounted for 87.75% of all medical institutions and 82.50% of patients were treated in a primary health clinic. The overall PFT performance rate was 23.47%, which was highest in tertiary hospitals (80.59%) and relatively lower in primary health clinics (17.06%). Oral agents were prescribed to 93.96% of patients, whereas inhaled agents were prescribed to only 30.34%. Oral corticosteroids were prescribed to 40.61% of patients, leukotriene antagonists to 48.78%, and inhaled corticosteroids (ICS) to 25.37% of patients by drug category. CONCLUSIONS: Most patients with asthma were treated in primary health clinics rather than higher class medical institutions. Asthma quality control was poor regarding usage of diagnostic measures and prescribed medications.

Current Epidemiological Data on Asthma Management in South Korea from Qualitative Assessment of Asthma Management by Health Insurance Review and Assessment Service (HIRA).

Since 2015, the Health Insurance Review and Assessment Service (HIRA) has performed annual qualitative assessments of asthma management provided by all medical institutions that care for asthma patients in Korea. According to the third report of qualitative assessment of asthma management in 2017, the assessment appears to have contributed to improving the quality of asthma care provided by medical institutions, especially primary clinics. However, there is still a gap between the ideal goals of asthma management and actual health care policies/regulations in real clinical settings, which leads to the state of standstill with respect to the quality of asthma management despite considerable efforts such as the qualitative assessment of asthma management by national agencies such as the HIRA. At this point, a harmonized approach is needed to raise the level of asthma management among several components including medical policies, efforts of academic associations such as education and distribution of the guideline for management, and reliable financial support by the government.