Treatment Patterns of Newly Diagnosed Asthma Patients in an Urban Setting in China: A Retrospective Longitudinal Real World Evidence Study

Abstract Background: Asthma is prevalent but largely undiagnosed and undertreated in China. Despite readily available effective therapies, the outcomes still leave much to be desired. There is a scarcity of data describing the treatment patterns of patients with newly diagnosed asthma in real world settings. The main goal of this study was to investigate treatment patterns of newly diagnosed asthma patients with up to 1 year follow-up to gain a better understanding of gaps of optimal asthma management in China. Methods : We conducted a large-scale of retrospective cohort analysis of asthma treatment for newly diagnosed patients using an electronic medical record database (SuValue). Eligible patients were at least 14 years old at the diagnosis from 2001 to March 2019. We categorized anti-asthmatic medication use by its classes and documented their use by the underlying disease severity. To examine the use of controlled medications over follow-ups, we summarized their utilization over consecutive 3-month time windows from the initial diagnosis to the end of follow-up. Results: A total of 26,301 patients from tertiary (25.24%), secondary (71.83%) and primary (2.92%) hospitals were included in the study; 54.01% received one or more controller medications during the study period and 30.4% had 12 months of follow-up visits. Initial prescriptions were inhaled corticosteroid (ICS)-containing controller treatment (13.9%), other controller treatment (31.59%), anti-asthmatic relivers (23.76%), symptomatic medications (14.54%) and no medication (16.2%). Patients mostly discontinued their controller prescriptions within 6 months after the initial diagnosis. Of the 45.98% patients not receiving any controller medication, 70.16% used relivers or symptomatic medications during follow-up visits. In patients who had 12-month follow-up visits, 76.86%, 17.25%, 5.88% were deemed to have mild, moderate, and severe asthma, respectively, during the 1 st 3 months. Percentages of severe and moderate asthma patients were halved by the 2 nd 3-month landmark and remained stable over the remaining follow-up visits. There were significant differences in asthma treatment between tertiary and secondary hospitals. Conclusion: In newly diagnosed asthma patients, controller medications were significantly underused while symptom-relief drugs, on the other hand, appeared to be overused. Poor adherence to current guidelines were common and more noticeable in lower tiered hospitals. These findings call for needs of more aggressive asthma management and more educational efforts in China.