German regional variation of acute and high oral corticosteroid use for asthma

Cassandra Nan, Olaf Schmidt, Robert Lindner, Yasemin Ilgin, Thomas Schultz, Lykke Hinsch Gylvin, Eugene R. Bleecker

Research output: Contribution to journalArticlepeer-review

5 Scopus citations


Objective: : To improve understanding of real-world asthma treatment and inform physician education, we evaluated regional variation in asthma prevalence and oral corticosteroid (OCS) use across Germany. Methods: : We developed a machine learning gradient-boosted tree model with IMS® Disease Analyzer electronic medical records, which cover 3% of German patients. This model had a 91% accuracy in predicting the presence of asthma and chronic obstructive pulmonary disease. We applied the model to the IMS® Longitudinal Prescription database, with 82% national coverage, to classify patients receiving treatment for airflow obstruction from October 2017–September 2018 in 63 regions in Germany. Results: : Of 2.4 million individuals under statutory health insurance predicted to have asthma, 13.7%, 18.7%, 36.5%, 29.4%, and 1.7% received treatment classified as Global Initiative for Asthma (GINA) Steps 1, 2, 3, 4, and 5, respectively. Approximately 7–15% of those at GINA Steps 1–4 and 35% at Step 5 treatment received ≥1 acute OCS prescription (duration <10 days). Of patients receiving GINA Steps 1–4 and Step 5 treatments, 1–3% and 86%, respectively, received ≥1 high-dosage OCS prescription. Cumulative OCS dosage and percentages of patients receiving OCS differed substantially across regions, and regions with lower OCS use had greater use of biologic therapies. Conclusions: : Both acute and high OCS use varied regionally across Germany, with overall use suggesting patients are considerable risk of adverse effects and long-term health consequences. Supplemental data for this article can be accessed at publisher’s website.

Original languageEnglish (US)
Pages (from-to)791-800
Number of pages10
JournalJournal of Asthma
Issue number4
StatePublished - 2022


  • Germany
  • bronchial disease
  • medical informatics
  • obstructive lung disease
  • resource allocation

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Immunology and Allergy
  • Pulmonary and Respiratory Medicine


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