guides triage and therapy decisions for COVID-19. Whether reported racial inaccuracies in oxygen saturation measured by pulse oximetry are present in patients with COVID-19 and associated with treatment decisions is unknown. OBJECTIVE To determine whether there is differential inaccuracy of pulse oximetry by race or ethnicity among patients with COVID-19 and estimate the association of such inaccuracies with time to recognition of eligibility for oxygen threshold-specific COVID-19 therapies. DESIGN, SETTING, AND PARTICIPANTSThis retrospective cohort study of clinical data from 5 referral centers and community hospitals in the Johns Hopkins Health System included patients with COVID-19 who self-identified as Asian, Black, Hispanic, or White.EXPOSURES Concurrent measurements (within 10 minutes) of oxygen saturation levels in arterial blood (SaO 2 ) and by pulse oximetry (SpO 2 ). MAIN OUTCOMES AND MEASURESFor patients with concurrent SpO 2 and SaO 2 measurements, the proportion with occult hypoxemia (SaO 2 <88% with concurrent SpO 2 of 92%-96%) was compared by race and ethnicity, and a covariate-adjusted linear mixed-effects model was produced to estimate the association of race and ethnicity with SpO 2 and SaO 2 difference. This model was applied to identify a separate sample of patients with predicted SaO 2 levels of 94% or less before an SpO 2 level of 94% or less or oxygen treatment initiation. Cox proportional hazards models were used to estimate differences by race and ethnicity in time to recognition of eligibility for guideline-recommended COVID-19 therapies, defined as an SpO 2 level of 94% or less or oxygen treatment initiation. The median delay among individuals who ultimately had recognition of eligibility was then compared. RESULTS Of 7126 patients with COVID-19, 1216 patients (63 Asian [5.2%], 478 Black [39.3%], 215 Hispanic [17.7%], and 460 White [37.8%] individuals; 507 women [41.7%]) had 32 282 concurrently measured SpO 2 and SaO 2 . Occult hypoxemia occurred in 19 Asian (30.2%), 136 Black (28.5%), and 64 non-Black Hispanic (29.8%) patients compared with 79 White patients (17.2%). Compared with White patients, SpO 2 overestimated SaO 2 by an average of 1.7% among Asian (95% CI, 0.5%-3.0%), 1.2% among Black (95% CI, 0.6%-1.9%), and 1.1% among non-Black Hispanic patients (95% CI, 0.3%-1.9%). Separately, among 1903 patients with predicted SaO 2 levels of 94% or less before an SpO 2 level of 94% or less or oxygen treatment initiation, compared with White patients, Black patients had a 29% lower hazard (hazard ratio, 0.71; 95% CI, 0.63-0.80), and non-Black Hispanic patients had a 23% lower hazard (hazard ratio, 0.77; 95% CI, 0.66-0.89) of treatment eligibility recognition. A total of 451 patients (23.7%) never had their treatment eligibility recognized, most of whom (247 [54.8%]) were Black. Among the remaining 1452 (76.3%) who had eventual recognition of treatment eligibility, Black patients had a median delay of 1.0 hour (95% CI, 0.23-1.9 hours; P = .01) longer than White patients. There was no signif...
Asthma is a chronic disease principally characterized by episodic wheeze, cough, and breathlessness resulting from airway hyperresponsiveness and inflammation. It is one of the most common chronic lung diseases in the United States, affecting approximately 8% of adults, or about 20 million individuals. 1,2 Consequently, asthma is frequently encountered in the primary care setting. In the vast majority of cases, asthma is successfully managed by the generalist, and most individuals with asthma are expected to achieve good control. This article summarizes the epidemiology, diagnosis, and chronic and acute management of asthma from the primary care perspective.
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