Impact of Inhaled Antiinflammatory Therapy on Hospitalization and Emergency Department Visits for Children With Asthma

Objective. Although the efficacy of inhaled antiinflammatory therapy in improving symptoms and lung function in childhood asthma has been shown in clinical trials, the effectiveness of these medications in real-world practice settings in reducing acute health care use has not been well-evaluated. This study examined the effect of inhaled antiinflammatory therapy on hospitalizations and emergency department (ED) visits by children for asthma. Design. Defined population cohort study over 1 year. Setting. Three managed care organizations (MCOs) in Seattle, Boston, and Chicago participating in the Pediatric Asthma Care–Patient Outcome Research and Treatment II trial. Participants. All 11 195 children, between 3 to 15 years old, with a diagnosis of asthma who were enrolled in the 3 MCOs between July 1996 and June 1997. Outcome Measures. We identified children with 1 or more asthma diagnoses using automated encounter data. Medication dispensings were identified from automated pharmacy data. Multivariate logistic regression analysis was used to calculate effects of inhaled antiinflammatory therapy on the adjusted relative risk (RR) for hospitalization and ED visits for asthma. Results. Over 12 months, 217 (1.9%) of children had an asthma hospitalization, and 757 (6.8%) had an ED visit. After adjustment for age, gender, MCO, and reliever dispensing, compared with children who did not receive controllers, the adjusted RRs for an ED visit were: children with any (≥1) dispensing of cromolyn, 0.4 (95% confidence interval [CI]: 0.3, 0.5); any inhaled corticosteroid (ICS), 0.5 (95% CI: 0.4, 0.6); any cromolyn or ICS combined (any controller), 0.4 (95% CI: 0.3, 0.5). For hospitalization, the adjusted RR for cromolyn was 0.6 (95% CI: 0.4, 0.9), for ICS 0.4 (95% CI: 0.3, 0.7), and for any controller 0.4 (95% CI: 0.3, 0.6). A significant protective effect for both events was seen among children with 1 to 5 and with >5 antiinflammatory dispensings. When the analysis was stratified by frequency of reliever dispensing, there was a significant protective effect for controllers on ED visits for children with 1 to 5 and with >5 reliever dispensings and on the risk of hospitalization for children with >5 reliever dispensings. Conclusions. Inhaled antiinflammatory therapy is associated with a significant protective effect on the risk for hospitalization and ED visits in children with asthma. Cromolyn and ICSs were associated with similar effects on risks.asthma drug therapy, inhaled antiinflammatory agents, health maintenance organizations, hospitalization, emergency department.

[1]  R. Platt,et al.  Epidemiology of community-acquired Clostridium difficile-associated diarrhea. , 1994, The Journal of infectious diseases.

[2]  M. Hughes,et al.  Effects of 22 months of treatment with inhaled corticosteroids and/or beta-2-agonists on lung function, airway responsiveness, and symptoms in children with asthma. The Dutch Chronic Non-specific Lung Disease Study Group. , 1992, The American review of respiratory disease.

[3]  J. Halterman,et al.  Inadequate therapy for asthma among children in the United States. , 2000, Pediatrics.

[4]  P. König,et al.  The effect of drug therapy on long-term outcome of childhood asthma: a possible preview of the international guidelines. , 1996, The Journal of allergy and clinical immunology.

[5]  E. Meltzer,et al.  Long-term comparison of three combinations of albuterol, theophylline, and beclomethasone in children with chronic asthma. , 1992, The Journal of allergy and clinical immunology.

[6]  O. Miettinen,et al.  Post-marketing studies of drug efficacy: how? , 1984, The American journal of medicine.

[7]  J. Price,et al.  Comparison of fluticasone propionate and sodium cromoglycate for the treatment of childhood asthma (an open parallel group study). , 1995, Respiratory medicine.

[8]  A. Elixhauser,et al.  Annual report on access to and utilization of health care for children and youth in the United States--1999. , 2000, Pediatrics.

[9]  I. Strannegård,et al.  Decrease in hospitalization for treatment of childhood asthma with increased use of antiinflammatory treatment, despite an increase in prevalence of asthma. , 1996, The Journal of allergy and clinical immunology.

[10]  Heather Eliassen,et al.  The Childhood Asthma Management Program (CAMP): design, rationale, and methods. Childhood Asthma Management Program Research Group. , 1999, Controlled clinical trials.

[11]  T. Pincus,et al.  Social Conditions and Self-Management Are More Powerful Determinants of Health Than Access to Care , 1998, Annals of Internal Medicine.

[12]  M. Korppi,et al.  Asthma treatment in schoolchildren: lung function in different therapeutic groups , 1996, Acta paediatrica.

[13]  E. Graves.  National Hospital Discharge Survey: annual summary, 1993. , 1995, Vital and health statistics. Series 13, Data from the National Health Survey.

[14]  S. Weiss,et al.  Inhaled steroids and the risk of hospitalization for asthma. , 1997, JAMA.

[15]  O S Miettinen,et al.  Post-marketing studies of drug efficacy: why? , 1984, The American journal of medicine.

[16]  K. Weiss,et al.  Reported difficulties in access to quality care for children with asthma in the inner city. , 1998, Archives of pediatrics & adolescent medicine.

[17]  S. Suissa,et al.  Patterns of increasing beta-agonist use and the risk of fatal or near-fatal asthma. , 1994, The European respiratory journal.

[18]  P. Gergen,et al.  An economic evaluation of asthma in the United States. , 1992, The New England journal of medicine.

[19]  S. Szefler,et al.  Alternative agents for anti-inflammatory treatment of asthma. , 1998, The Journal of allergy and clinical immunology.

[20]  A. Berger.  FUNDAMENTALS OF BIOSTATISTICS , 1969 .

[21]  P. Fishman,et al.  Health care utilization and cost among children with asthma who were enrolled in a health maintenance organization. , 1997, Pediatrics.

[22]  A. Buist,et al.  Temporal trends in hospital-based episodes of asthma care in a health maintenance organization. , 1993, The American review of respiratory disease.

[23]  J. Boivin,et al.  First treatment with inhaled corticosteroids and the prevention of admissions to hospital for asthma , 1998, Thorax.

[24]  B. Lipworth,et al.  Reduced protection against exercise induced bronchoconstriction after chronic dosing with salmeterol. , 1994, Respiratory medicine.

[25]  S. Pedersen,et al.  Effects of long-term treatment with an inhaled corticosteroid on growth and pulmonary function in asthmatic children. , 1994, Respiratory medicine.

[26]  E. Fisher,et al.  Why are children hospitalized? The role of non-clinical factors in pediatric hospitalizations. , 1994, Pediatrics.

[27]  P. Newacheck,et al.  Childhood asthma and poverty: differential impacts and utilization of health services. , 1993, Pediatrics.

[28]  M. Ennis,et al.  Bronchoalveolar lavage findings suggest two different forms of childhood asthma , 1997, Clinical and experimental allergy : journal of the British Society for Allergy and Clinical Immunology.

[29]  A. Elixhauser,et al.  Annual report on access to and utilization of health care for children and youth in the United States--2000. , 2001, Ambulatory pediatrics : the official journal of the Ambulatory Pediatric Association.