Should a prescription database be used to search uncontrolled severe asthmatics?

Introduction: Many uncontrolled severe asthmatics are not on biologic therapy. We hypothesized that using a prescription database could help us identify them. Material and methods: 3,309 patients, who received at least one Montelukast prescription in 2019, were extracted from our prescription database. Number of packages/year, types and dosages of ICS, LABA, ICS/LABA, LAMA and monoclonal antibodies were considered for each patient. In our analysis, for subjects that took > 7 packages of ICS/LABA + LTRA +/– LAMA (high adherent) the number of oral corticosteroids (OC) packets prescribed for each of them was also looked upon. Results: Patients that took ICS/LABA or ICS/LABA + LAMA continuously with high ICS doses were 188 (25.6%) and 117 (39.3%) respectively (total: 305 — 29.5%). Among them, 58 (30.9%) and 53 (45.3%) (total: 111 — 36.4%) were prescribed more than 2 OC packages. Whereas, 21 (11.2%) and 24 (20.5%) patients (total: 45 — 14.75%) received at least 4 OC package prescriptions. Conclusions: Approximately 36% of patients in continuous step-4/5 of GINA guidelines treatment may have severe uncontrolled asthma (overusing OC) which needed biologic treatment. In our opinion, a prescription archiving database may be a tool that can help us identify patients with severe asthma phenotype that would deserve a biologic treatment.