Oral Corticosteroids Dispensed

Description:

Our oral corticosteroid use (dispensed) measure uses claims data to determine the percentage of patients in our population (Adult Asthma, Pediatric Asthma, and COPD) with 0, 1, or 2+ oral corticosteroid medication claims (total number of oral corticosteroid fills) in the measurement year.  A lower proportion with 2+ OCS fills indicates better performance.

Population Specifics:

• Asthma patients, regardless of severity, aged 2 years and older.
• COPD patients aged 40 years and older.

Numerator/Denominator

• Denominator: Eligible patients, excluding those with conditions known to be associated with OCS use.
• Numerator: Eligible patient included in the denominator for whom an OCS medication is dispensed 0, 1, 2+ time in the measurement year.

Rationale:

• COPD (GOLD 2023):
  • “Oral glucocorticoids have numerous side effects, including steroid myopathy which can contribute to muscle weakness, decreased functionality, and respiratory failure in people with very severe COPD” (Pg.. 65).
  • “…while oral glucocorticoids play a role in the acute management of exacerbations, they have no role in the chronic daily treatment in COPD because of a lack of benefit balanced against a high rate of systemic complication” (Pg. 65).
• Asthma (GINA 2022):
  • “Uncontrolled asthma includes frequent exacerbations (2 or more per year) requiring OCS, or serious exacerbations (one or more per year) requiring hospitalization” (Pg. 105).
  • “…as a last resort, add-on low dose oral corticosteroids may be considered for some adults with severe asthma, but they are often associated with substantial side effects. They should only be considered for adults with poor symptoms control and/or frequent exacerbations despite good inhaler technique and adherence with Step 5 treatment, and after exclusion of other contributory factors and other add-on treatment including biologics where available and affordable. Patients should be counseled about potential side-effects. They should be assessed and monitored for risk of adrenal suppression and corticosteroid-induced osteoporosis, and those expected to be treated for 3 or more months should be provided with relevant lifestyle counseling and prescription of therapy for prevention of osteoporosis (where appropriate)” (Pg. 73).
  • Indications for considering referral for expert advice, where available (Pg. 87):
    • Patients with significant side-effects from treatment.
    • Need for long-term oral corticosteroid use.
    • Frequent courses of oral corticosteroids (e.g., two or more course a year)

Guideline Links:

• GOLD 2024 Guidelines: 2024 GOLD Report
• GINA 2022 Guidelines: 2022 GINA Main Report 
• GINA 2023 Guidelines: 2023 GINA Main Report