A primary care database study of asthma among patients with and without opioid use disorders

Opioid use disorder's impact on asthma hospitalizations: A propensity-matched nationwide study

BACKGROUND

Patients with asthma and opioid use disorder (OUD) experience higher rates of acute exacerbation, but the effects of OUD on asthma hospitalizations have been poorly described.

OBJECTIVE

To explore how concurrent OUD may affect the clinical outcomes of adult patients hospitalized for asthma.

METHODS

Using the National Inpatient Sample, adult patients admitted for asthma with concomitant OUD were identified and compared with those without OUD. Cohorts were matched in a 1:1 ratio using propensity score matching, with mortality as primary outcome of interest.

RESULTS

A total of 491,990 patients were hospitalized for asthma, and 3.49% had a concomitant diagnosis of OUD. Patients with asthma and OUD were younger, with a mean age of 41 years (SD ± 12.2) vs 51 years (SD ± 17.2) in those without OUD. After matching, both cohorts had 17,125 patients. There was no significant difference regarding in-hospital mortality (odds ratio [OR] 0.92, 95% CI 0.51-1.63, P = .77) between the cohorts. Patients with asthma with OUD had significantly higher rates of mechanical ventilation (OR 1.52, 95% CI 1.23-1.87, P < .001), noninvasive mechanical ventilation (OR 1.37, 95% CI 1.15-1.62, P < .001), and mean length of stay (3.18 vs 2.92 days, P < .001) compared with patients with asthma without OUD. Patients with OUD had no difference in mean total hospitalization costs ($33,514 vs $31,529, P = .054) compared with patients without OUD. Compared with a routine hospital discharge, patients with OUD were more likely to leave against medical advice (relative risk [RR] 2.67, 95% CI 2.28-3.13, P < .001), be discharged to a long-term facility (RR 1.40, 95% CI 1.01-1.95, P = .045), and be discharged with home health care (RR 1.56, 95% CI 1.22-1.99, P < .001) than patients without OUD.

CONCLUSION

Concomitant OUD has no impact on mortality in asthma hospitalizations, but patients with asthma with OUD have worse secondary outcomes compared with those without OUD.

Investigating the association between asthma and opioid use disorder with interactions of anxiety and depression among a national sample of the US population

INTRODUCTION

Previous studies have not examined the association between asthma and opioid use disorder (OUD) in a comprehensive national sample of the U.S. population. This study aims to investigate such an association.

METHODS

This is a matched retrospective cohort study, with a follow-up period of two years, utilizing longitudinal electronic medical records of a comprehensive national healthcare database in the U.S.-Cerner-Real World DataTM. Patients selected for analysis were ≥12 years old with a hospital encounter between January 2000 and June 2020. Adjusted risk ratios (aRRs) of incident OUD for those with asthma compared to those without asthma were calculated using a modified Poisson regressions with robust standard errors via the Huber-White sandwich estimator, and results were stratified by comorbid mental illnesses.

RESULTS

Individuals with asthma had a greater risk of OUD compared to those without asthma (aRR = 2.12; 95% CI 2.03-2.23). When stratified by anxiety and depression status, individuals with asthma and no anxiety or depression had a greater risk of incident OUD compared to individuals with asthma and either anxiety, depression, or both. Additionally, individuals with asthma medication had 1.29 (95% CI: 1.24, 1.35) greater overall risk for incident OUD compared to those without medication. Independent of comorbid mental illnesses, individuals with asthma medication had greater risk for incident OUD compared to those without medication among individuals without severe/obstructive asthma.

CONCLUSIONS

Individuals with asthma face a higher OUD risk compared to those without asthma. Comorbid mental illnesses modulate this risk. Caution is advised in opioid prescribing for asthma patients.

Factors Associated with Substance Use Disorder among High-Need Adolescents and Young Adults in North Carolina

Background

Prevalence of substance use disorders (SUD) is high among adolescents and young adults (AYAs) with complex medical needs. Little is known about risk factors for SUD in this population.

Methods

This retrospective cohort study used electronic health record data from a large academic hospital system (2015-2019) to identify adolescents (aged 10-17) and young adults (aged 18-27) with intellectual/developmental disorders, psychiatric conditions, or complex medical conditions. Logistic regression was used to identify demographic, clinical, and neighborhood-level risk factors associated with SUD in this population.

Results

A total of 149 adolescents and 536 young adults had a SUD diagnosis (6.7% and 20.6%, respectively). Among adolescents, notable risk factors for SUD included age (adjusted odds ratio [aOR] = 1.42, 95% confidence interval [CI] = [1.31, 1.54]), Hispanic ethnicity (aOR = 2.10, 95% CI = [1.10, 3.99]), additional psychoactive medication classes (aOR = 1.27, 95% CI = [1.11, 1.46]), and living in a "high" child opportunity index (COI) (aOR = 2.06, 95% CI [1.02, 4.14]) or a "very high" COI (aOR = 3.04, 95% CI [1.56,5.95]) area. Among young adults, notable risk factors included being male (aOR = 2.41, 95% CI [1.91, 3.05]), being Black (aOR = 1.64, 95% CI [1.28, 2.09]), and additional non-psychoactive (aOR = 1.07, 95% CI [1.03, 1.11]) or psychoactive medication classes (aOR = 1.17, 95% CI [1.07, 1.28]).

Limitations

These descriptive analyses are limited to one large academic hospital system in North Carolina and may not be representative of all high-need AYAs in the state.

Conclusions

Several demographic, clinical, and neighborhood risk factors are associated with SUD in high-need AYAs.

Prescriptions of opioid-containing drugs in patients with chronic cough

BACKGROUND

Chronic cough (CC) affects about 10% of adults, but opioid use in CC is not well understood.

OBJECTIVES

To determine the use of opioid-containing cough suppressant (OCCS) prescriptions in patients with CC using electronic health records.

DESIGN

Retrospective cohort study.

METHODS

Through retrospective analysis of Midwestern U.S. electronic health records, diagnoses, prescriptions, and natural language processing identified CC - at least three medical encounters with cough, with 56-120 days between first and last encounter - and a 'non-chronic cohort'. Student's t-test, Pearson's chi-square, and zero-inflated Poisson models were used.

RESULTS

About 20% of 23,210 patients with CC were prescribed OCCS; odds of an OCCS prescription were twice as great in CC. In CC, OCCS drugs were ordered in 38% with Medicaid insurance and 15% with commercial insurance.

CONCLUSION

Findings identify an important role for opioids in CC, and opportunity to learn more about the drugs' effectiveness.

Epidemiological associations of asthma status and tobacco use, substance use, and substance misuse among adults in the United States, 2015-2019

Objective: Adults with asthma have a higher prevalence of substance use. However, knowledge is scarce regarding the associations between adults with asthma and tobacco use, substance use, and substance misuse. This study aimed to use national samples of United States adults to assess the comprehensive use and misuse of substances in adults with asthma.Method: This cross-sectional study comprised data drawn from the 2015 to 2019 National Survey on Drug Use and Health. Weighted logistic regressions were used to measure the associations of asthma status (lifetime and current) with last month's tobacco use; substance use (alcohol, marijuana, cocaine, crack, heroin, hallucinogens, inhalants); and substance misuse (pain relievers, tranquilizers, stimulants, sedatives). All regression models were controlled for sociodemographic characteristics, comorbidity, last-month serious psychological distress, and co-substance use and misuse. Results: Adults with lifetime asthma (N_weighted = 115,600,887) were less likely to use cigarettes, cigars, smokeless tobacco, inhalants, and polyuse of any substance. In contrast, adults with current asthma (N_weighted = 765,096,31) were more likely to use pipe tobacco, cocaine, non-prescribed tranquilizers, and less likely to use polytobacco products. Adults with lifetime asthma were associated with fewer last-month tobacco and inhalant use than those without lifetime asthma. However, adults with current asthma were associated with greater last month's pipe tobacco, cocaine, and non-prescribed tranquilizers. Conclusion: Thus, further longitudinal studies are recommended among adults with asthma to effectively design tailored treatment and prevention interventions.

Risk of asthma exacerbation associated with opioid and nonopioid analgesic use in children with current asthma

BACKGROUND: In the United States, asthma occurs in a vast proportion of children and adolescents. Asthma exacerbation is an acute episodic event typically characterized by difficulty in breathing, chest tightness, coughing, or wheezing. Severe asthma exacerbation can be life-threatening and lead to service utilizations such as hospitalizations and emergency department (ED) visits. Opioid analgesic use can trigger an asthma exacerbation through 2 pharmacological mechanisms. Despite the potential mechanisms, there is lack of empirical evidence to determine the risk of asthma exacerbation and its association with opioid use. OBJECTIVE: To evaluate the risk of asthma exacerbation in children with current asthma receiving an opioid vs a nonopioid analgesic. METHODS: Eligible individuals aged under 18 years with current asthma and receiving an incident analgesic prescription were identified from a large Medicaid managed care database during 2013-2018. Current asthma was defined as receipt of an asthma diagnosis and an antiasthmatic medication in the 12 months before analgesic medication initiation. Asthma exacerbation was defined as a hospitalization or ED visit with asthma as either the primary or secondary diagnosis within 3 days of receipt of an analgesic prescription. A weighted multivariable logistic regression using inverse probability treatment weighting was performed to test the association between use of analgesic medication and risk of asthma exacerbation. RESULTS: This study included 13,359 children with current asthma who filled either an incident opioid (n = 5,363, 40.1%) or nonopioid analgesic (n = 7,996, 59.9%) prescription. Asthma exacerbation was observed in 24 (0.5%) opioid analgesic recipients and 22 (0.3%) nonopioid analgesic recipients within 3 days of analgesic initiation. Weighted logistic regression results showed that children receiving opioid analgesics (adjusted odds ratio = 1.6, 95% CI = 0.9-2.9) did not have a statistically significantly higher risk of asthma exacerbation than their nonopioid analgesic recipient counterparts in the propensity score-weighted multivariable analysis. CONCLUSIONS: Asthma exacerbation associated with analgesic use in children with current asthma was an uncommon event, and the risk was comparable among children receiving opioid vs nonopioid analgesics. DISCLOSURES: This study was supported and funded by the Agency for Healthcare Research and Quality (AHRQ), Project Number: 1R03HS026790-01A1. The study content was solely the responsibility of the authors, and AHRQ had no role in the design and conduct of the study. The authors have nothing to disclose.