Poor adherence to inhaled corticosteroids associated with asthma-related intensive care admissions

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Background: Inhaled corticosteroids (ICS) are the cornerstone of asthma management with poor adherence being a known risk factor for asthma exacerbations. We reviewed the relationship between ICS adherence and acute severe asthma (ASA) requiring ICU admission. Methods: Clinical details of adult asthma patients admitted to the ICU over 24 months at a tertiary hospital were retrospectively reviewed. ICS adherence was evaluated using Medication Possession Ratio (MPR) in the 12 months prior to ICU admission, with MPR ≥75% indicating adherence. Results: Of 29 patients admitted to ICU for ASA, 5 were excluded due to unavailable prescription data. Among 24 patients, 10 (42%) were known to secondary care, 11 (45%) were male, mean age 44.5 years (SD 15.03). Mean ICU stay was 3.5 days (SD 3.56). Median blood eosinophil count was 400 cells/uL (IQR 200-750).18 patients (75%) were on an ICS-containing inhalers; 6(25%) were ICS-naïve (but were prescribed salbutamol), 2 of whom were newly diagnosed asthma during this admission. 12/18 ICS users (67%) were non-adherent, with an average MPR of 50%. 10 (42%) had no ICS prescribed in the month prior to ICU admission. 6 patients (25%) required mechanical ventilation, of these, 4 patients had not collected ICS prescription in the month prior to admission. Regression analysis showed a significant negative relationship between MPR and mechanical ventilation Conclusion: Most patients admitted to ICU due to ASA were ICS non-adherent with one in six patients not prescribed regular ICS. Ensuring ICS prescribing and adherence support is crucial to improving asthma outcomes.

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