Abstract
Background Asthma exacerbations are major contributors to asthma morbidity and mortality. They are usually managed with bronchodilators and oral corticosteroids (OCS), but clinical trial evidence suggests that antibiotics could be beneficial. We aimed to assess whether treatment of asthma exacerbations with antibiotics in addition to OCS improved outcomes in larger, more representative routine-care populations.
Method A retrospective comparative effectiveness study into managing asthma exacerbations with OCS alone versus OCS plus antibiotics was conducted using the Optimum Patient Care Research Database. The dataset included 28 637 patients; following propensity score matching 20 024 adults and 4184 children were analysed.
Results Antibiotics in addition to OCS were prescribed for the treatment of asthma exacerbations in 45% of adults and 32% of children. Compared to OCS alone, OCS plus antibiotics was associated with reduced risk of having an asthma/wheeze consultation in the following 2 weeks (children hazard ratio (HR) 0.84 (95% CI 0.73–0.96), p=0.012; adults HR 0.86 (95% CI 0.81–0.91), p<0.001), but an increase in risk of a further OCS prescription for a new/ongoing exacerbation within 6 weeks in adults (HR 1.11 (95% CI 1.01–1.21), p=0.030), but not children. Penicillins, but not macrolides, were associated with a reduction in the odds of a subsequent asthma/wheeze consultation compared to OCS alone, in both adults and children.
Conclusion Antibiotics were frequently prescribed in relation to asthma exacerbations, contrary to guideline recommendations. Overall, the routine addition of antibiotics to OCS in the management of asthma exacerbations appeared to confer little clinical benefit, especially when considering the risks of antibiotic overuse.
Abstract
Antibiotics are regularly prescribed for asthma exacerbation; however, there is little clinical benefit to the routine addition of antibiotics to usual OCS treatment for managing asthma exacerbations in primary care patients https://bit.ly/2LvYbfT
Footnotes
This article has an editorial commentary: https://doi.org/10.1183/13993003.00183-2021
This article has supplementary material available from erj.ersjournals.com
Conflict of interest: C.S. Murray reports personal fees from AstraZeneca, Thermo Fisher, Boehringer Ingelheim, GSK and Novartis, outside the submitted work.
Conflict of interest: S.J. Lucas has nothing to disclose.
Conflict of interest: J. Blakey reports personal fees and non-financial support from AstraZeneca and Boehringer Ingelheim, personal fees from TEVA, non-financial support from GSK, grants from Novartis, outside the submitted work.
Conflict of interest: A. Kaplan reports personal fees from AstraZeneca, Behring, Boehringer Ingelheim, GSK, Novartis, Reva, Covis, Merck, Trudell, Pfizer, Purdue, NovoNordisk and Griffols, outside the submitted work.
Conflict of interest: A. Papi reports grants, personal fees for advisory board work, lectures and consultancy, and non-financial support (travel expenses reimbursement) from GlaxoSmithKline, AstraZeneca, Boehringer Ingelheim, Chiesi Farmaceutici and TEVA, personal fees for advisory board work, lectures and consultancy, and non-financial support (travel expenses reimbursement) from Mundipharma, Zambon, Novartis and Sanofi/Regeneron, grants, personal fees for lectures and non-financial support (travel expenses reimbursement) from Menarini, personal fees for advisory board work and non-financial support (travel expenses reimbursement) from Roche, grants from Fondazione Maugeri and Chiesi, personal fees for consultancy from Edmondpharma, outside the submitted work.
Conflict of interest: J. Paton has nothing to disclose.
Conflict of interest: W. Phipatanakul reports grants and personal fees for consultancy from Genentech/Novartis and Regeneron/Sanofi, other (reagent support) from Thermo Fisher, other (clinical trial/medication support) from GSK and Kaleo, other (clinical trial support) from Lincoln Diagnostics and Monaghen, during the conduct of the study.
Conflict of interest: D. Price reports grants and personal fees for advisory board work, consultancy and lectures from AstraZeneca, Chiesi, Boehringer Ingelheim, Teva Pharmaceuticals, Novartis, Mylan and Mundipharma, grants and personal fees for advisory board work from Circassia, grants and personal fees for advisory board work and lectures from Regeneron Pharmaceuticals and Sanofi Genzyme, grants and personal fees for consultancy from Pfizer and Theravance, grants from Respiratory Effectiveness Group and UK National Health Service, personal fees for advisory board work and consultancy from Amgen, personal fees for advisory board work, consultancy and lectures from GSK, personal fees for lectures from Cipla and Kyorin, personal fees for advisory board work and travel to meetings from Thermofisher, outside the submitted work; and has stock/stock options from AKL Research and Development Ltd, which produces phytopharmaceuticals; owns 74% of the social enterprise Optimum Patient Care Ltd (Australia and UK) and 74% of Observational and Pragmatic Research Institute Pte Ltd (Singapore); is peer reviewer for grant committees of the Efficacy and Mechanism Evaluation programme, and Health Technology Assessment; and was an expert witness for GlaxoSmithKline.
Conflict of interest: O.H. Teoh has nothing to disclose.
Conflict of interest: M. Thomas reports personal fees from GSK, Novartis and Boehringer Ingelheim, outside the submitted work.
Conflict of interest: S. Turner has nothing to disclose.
Conflict of interest: N.G. Papadopoulos reports personal fees for advisory board work and lectures from Novartis, Nutricia, HAL, Menarini/Faes Farma and Mylan/Meda, personal fees lectures from Sanofi, Biomay, MSD, Asit Biotech and Boehringer Ingelheim, personal fees for advisory board work from AstraZeneca and GSK, grants from Gerolymatos International SA and Capricare, outside the submitted work.
Support statement: This project was supported by the Respiratory Effectiveness Group. Data and data management support was provided in kind by Optimum Patient Care (www.opcrd.co.uk) and Derek Skinner at OPC. C.S. Murray is supported by the NIHR Manchester Biomedical Research Centre. Funding information for this article has been deposited with the Crossref Funder Registry.
- Received May 22, 2020.
- Accepted December 7, 2020.
- Copyright ©ERS 2021
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