Journal of Asthma and Allergy (Aug 2023)

Health Care Situation in the Treatment of Uncontrolled GINA Step 4/5 Patients in Germany

  • Timmermann H,
  • Milger K,
  • Virchow JC,
  • Schmidt O,
  • Bergmann KC,
  • Koschel D,
  • Neurohr C,
  • Scholz F,
  • Heck S,
  • Skowasch D

Journal volume & issue
Vol. Volume 16
pp. 813 – 820

Abstract

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Hartmut Timmermann,1 Katrin Milger,2 Johann Christian Virchow,3 Olaf Schmidt,4 Karl-Christian Bergmann,5 Dirk Koschel,6 Claus Neurohr,7 Florian Scholz,8 Sebastian Heck,9 Dirk Skowasch10 1Schwerpunktpraxis Colonnaden, Hamburg, Germany; 2Medicine V, Ludwig-Maximilians-University (LMU) Munich, Member of the German Center for Lung Research (DZL), Comprehensive Pneumology Center Munich (CPC-M), Munich, Germany; 3Abteilungen für Pneumologie / Intensivmedizin, Universitätmedizin Rostock, Rostock, Germany; 4Studienzentrum KPPK, Pneumologische Gemeinschaftspraxis, Koblenz, Germany; 5Institute of Allergology, Charité–Universitätsmedizin, Fraunhofer Institute for Translational Medicine and Pharmacology ITMP, Allergology and Immunology, Corporate Member of Freie Universität Berlin and Humboldt-Universität Berlin, Berlin, Germany; 6Fachkrankenhaus Coswig, Lung Centre, Coswig, and Division of Pulmonology, Medical Department I, University Hospital Carl Gustav Carus, Dresden, Germany; 7Abteilung für Pneumologie und Beatmungsmedizin, Robert-Bosch-Krankenhaus Lungenzentrum Stuttgart, Stuttgart, Germany; 8IQVIA Commercial GmbH & Co. OHG, Frankfurt am Main, Germany; 9GlaxoSmithKline GmbH & Co. KG, Munich, Germany; 10Department of Internal Medicine II – Pneumology, University Hospital Bonn, Bonn, GermanyCorrespondence: Hartmut Timmermann, Schwerpunktpraxis Colonnaden 72, Hamburg, 20354, Germany, Tel +49 4086648880, Fax +49 40866488824, Email [email protected]: It has been estimated that, in 2019, 54,000 patients in Germany had uncontrolled GINA step 4/5 asthma. In the current study we analyzed which health care providers were involved in the management of these patients and their role in disease phenotyping.Patients and Methods: The year 2019 was retrospectively analyzed using the IQVIATM LRx, a longitudinal anonymized prescription database, and the electronic, anonymized medical records database, the IQVIA Disease Analyzer.Results: Of 54,000 uncontrolled GINA step 4/5 asthma patients in Germany, 52% had consulted both general practitioners (GPs) and pulmonologists, and 48% were seen exclusively by a GP. Of these 54,000 patients, 45% were being prescribed and were thus overusing short-acting β 2-agonists (SABAs) and oral corticosteroids (OCS) for ≥ 2 years, 26% for ≥ 3 years, and 16% for ≥ 4 years. In most regions, pulmonologists saw one of their uncontrolled GINA step 4/5 asthma patients per week. Laboratory tests from consultations with a GP were available for only 10% of patients referred to a pulmonologist. In 50% of uncontrolled asthma patients treated according to GINA step 4/5, these were initiated by the pulmonologist, and 34% received laboratory testing within the first year (in GINA step 4/5 asthma, the numbers are 20% and 18%, respectively).Conclusion: Fifty percent of uncontrolled asthma patients treated according to GINA step 4/5 were regularly seen by pulmonologists, who performed most of the phenotyping confirming their importance in the management of severe, uncontrolled asthma in Germany. To understand treatment pathways for these patients, further studies are needed.Keywords: prescription database, biological treatment, laboratory test, uncontrolled GINA step 4/5 asthma, Germany

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