Chest
Volume 126, Issue 1, July 2004, Pages 75-80
Journal home page for Chest

Clinical Investigations
ASTHMA
Treatment Patterns in the Months Prior to and After Asthma-Related Emergency Department Visit

https://doi.org/10.1378/chest.126.1.75Get rights and content

Background:

There are 2 million asthma-related emergency department (ED) events each year in the United States. The underrecognition and undertreatment of asthma is believed to be associated with this high level of morbidity. This study was designed to describe the treatment patterns in the year prior to the ED event and for 2 months after the event.

Methods:

This retrospective observational study utilized an integrated managed care database that contained administrative claims from > 20 managed care plans across the United States. All patients with at least one ED visit for asthma during 2001 were included. Patients were required to have data available 12 months prior to and 2 months following the ED visit of interest, and were excluded if they had made an asthma-related ED visit within 12 months of the identified event.

Results:

There were 12,636 patients identified with an asthma-related ED visit. In the year prior to the ED event, 25.1% of the patients received an inhaled corticosteroid (ICS), 29.9% received an oral corticosteroid (OCS), and 53.5% received a short-acting β-agonist (SABA). Overall, there were three albuterol units dispensed for every ICS unit dispensed in the 12-month period prior to the ED event. Ninety-four percent of patients had made an office visit in the prior year, but only 13.3% underwent spirometry testing. Prescriptions dispensed for ICSs and OCSs increased 2.6-fold and 7.5-fold, respectively, in the month after the ED event, and dispensing rates reverted approximately to baseline rates by the second month after the index ED event.

Conclusion:

This study demonstrates the dependence of this population on the use of rescue medications, including SABA and OCS, to treat their asthma. Furthermore, the ED event resulted in only an incremental short-term improvement in ICS-containing controller treatment.

Section snippets

Materials and Methods

This study is a descriptive retrospective analysis focusing on the 12 months prior to and the 2 months following an initial asthma-related ED visit. During this time period, patient demographics, comorbid conditions, asthma-related medical claims (eg, medications, office visits, and spirometry procedures for patients ≥ 6 years of age), and office visits associated with other diagnoses were collected by month. The number of claims for asthma medications dispensed was calculated as well as the

Results

There were 12,636 patients identified with an asthma-related ED visit. Hospitalizations were reported in 10.5% of these patients. Children aged 0 to 17 years comprised 43.5% of the total number of subjects. The mean age of patients in the released cohort was 25.8 years. Patients who were subsequently hospitalized were slightly older, with a mean age of 31.0 years. Women comprised 58.8% of the total cohort. During the observation period, comorbid acute upper respiratory infections were reported

Discussion

This analysis demonstrates the greater dependence for this population on rescue medications including SABAs and OCSs. OCSs were dispensed to 30% of the patients in the year prior to an asthma-related ED event and to 39% of patients in the 12 months prior to a hospitalization. The mean number of rescue medications was consistent over the 12 months prior to the event and did not appear to be dispensed as an intervention to prevent the index ED event. Although pharmacy claims do not indicate

References (17)

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This study was supported by GlaxoSmithKline, Research Triangle Park, NC.

Dr. Stempel is a consultant for GlaxoSmithKline, Dr. Roberts was an employee of NDCHealth at the time of article submission, and Dr. Stanford is an employee of GlaxoSmithKline.

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