Bleecker, E

Boggs, R

Long, A

O'Connor, R

Parasuraman, B

Peters, S

Silkoff, P

Tashkin, D

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PAA11 A 4-YEAR ASSESSMENT OF SUB-ACUTE LACK OF ASTHMA CONTROL IN A REAL-WORLD SETTING 

A112 Abstracts
Guideline-recommended minimum 3-year course of therapy.
Among the 308 patients receiving IT who were included in clin-
ical and economic subanalyses, average IT cost was $20 (SD $23)
per administration and $468 (SD $543) over the treatment
course. Pharmacy, outpatient and inpatient costs signiﬁcantly
decreased in the 6 months following completion of IT versus the
6 months prior to IT initiation (−$78, p = 0.0125; −$273, p =
0.0005; −$2123, p = 0.0092 respectively). CONCLUSION: We
found wide variation in IT delivery by sex and race. Despite the
preponderance of premature IT discontinuation among patients
in our study, signiﬁcant cost savings were demonstrated. Find-
ings suggest that patients with AR and the health care systems
that provide care to these patients may beneﬁt from broader
access and improved adherence to IT.
PAA11
A 4-YEAR ASSESSMENT OF SUB-ACUTE LACK OF ASTHMA
CONTROL IN A REAL-WORLD SETTING
Long A1, Bleecker E2, O’Connor R3,Tashkin D4, Peters S2, Silkoff P5,
Parasuraman B5, Boggs R6
1Massachusetts General Hospital, Boston, MA, USA, 2Wake Forest
University, Winston-Salem, NC, USA, 3Sharp Rees-Stealy Medical
Group, San Diego, CA, USA, 4UCLA, Los Angeles, CA, USA,
5AstraZeneca, Wilmington, DE, USA, 6Formerly AstraZeneca,
Wilmington, DE, USA
OBJECTIVES: To assess in a managed care setting the sub-acute
lack of asthma control (SALAC) identiﬁed by excess short-acting
ß2-agonist (SABA) use or clinic visits but not necessarily associ-
ated with acute asthma exacerbations. METHODS: An admin-
istrative claims database containing 8.8 million lives was
analyzed over 4 years (June 2000–May 2004). Patients aged ≥12
years with an ICD-9 code for asthma and ≥2 claims/year for
asthma medication were included; those with other signiﬁcant
respiratory conditions were not. SALAC was deﬁned as >4 clinic
visits for asthma/year or ≥2/quarter, or >5 SABA prescrip-
tions/year. Acute asthma exacerbations were deﬁned as asthma-
related emergency department visits, hospitalizations, or oral
corticosteroid bursts. SALAC rates during years 2–4 were com-
pared for patients who had loss of control during year 1 with
patients who did not. RESULTS: Of 3998 patients (mean age =
41 years, 65% female) who met the study criteria, only 42% had
an acute exacerbation but 70% had SALAC in the 4-year period
(63% excess clinic visits/year, 36% excess SABA/year); 22% had
SALAC in only 1 of the 4 years, 16% in 2 of the 4 years, 14%
in 3 of the 4 years, and 18% in all 4 years. Patients experienc-
ing SALAC in year 1 were more likely to do so again in years
2–4 vs. all other patients (83% v. 47%; p < 0.001). SALAC
rates/year changed little over the 4-year period (year 1: 44%;
year 2: 45%; year 3: 42%; year 4: 37%). CONCLUSION: A
sub-acute loss of asthma control (SALAC) in 1 year predicts
SALAC in a subsequent year. SALAC occurred in more than two
thirds of patients at some point and occurred every year in
almost one ﬁfth. Asthma control is also lacking in many patients
who did not have an acute exacerbation.
PAA13
CATEGORIES AND TRANSITION PATTERNS OF GUIDELINE
INFORMED CONTROL IN SEVERE OR DIFFICULT-TO-TREAT
ASTHMA
Campbell JC1, Sullivan SD
University of Washington, Seattle, WA, USA
OBJECTIVE: In their 2007 guidelines, the National Asthma
Education and Prevention Program (NAEPP) recommends
assessing a patient’s level of asthma control to determine an
appropriate management strategy. We sought to describe the
levels and transition patterns of asthma control as deﬁned by the
new NAEPP guidelines for an adult asthma cohort with severe
or difﬁcult-to-treat disease. METHODS: We used The Epidemi-
ology and Natural History of Asthma: Outcomes and Treatment
Regimens (TENOR) adult cohort to describe their NAEPP
informed levels of asthma control. TENOR was a three year,
multicenter, prospective study of patients with severe or difﬁcult-
to-treat asthma that received standard of care. TENOR adults
were semi-annually categorized into three levels of asthma
control: controlled, partly controlled, and uncontrolled. We
measured impairment with spirometry and the validated Asthma
Therapy Assessment Questionnaire (ATAQ) and measured exac-
erbation risk with health care utilization outcomes. RESULTS:
A total of 3488 adults (≥18 years of age) had a mean follow-up
of 25 months. At baseline, 12.5% were controlled, 34.9% were
partly controlled, and 52.6% were uncontrolled. Out of 15,569
control assessments across all visits, 15.3% were controlled,
35.0% were partly controlled, and 49.7% were uncontrolled.
Data was missing on an additional 1476 (8.7%) observations
across all completed visits. Six month transition patterns of
control yielded: 63.4% of controlled patients remained con-
trolled, 65.2% of partly controlled patients remained partly 
controlled, and 82.4% of uncontrolled patients remained uncon-
trolled. CONCLUSIONS: The results suggest that the majority
PAA12
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PAA11 A 4-YEAR ASSESSMENT OF SUB-ACUTE LACK OF ASTHMA CONTROL IN A REAL-WORLD SETTING

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