Inhaled Steroids and the Risk of Hospitalization for Asthma

Donahue, James G.; Weiss, Scott T.; Livingston, James M.; Goetsch, Marcia A.; Greineder, Dirk K.; Platt, Richard

doi:10.1001/jama.1997.03540350037030

Cited by 397 publications

(66 citation statements)

References 23 publications

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“…Al though this type of anal y sis has not pre vi ous ly yet been per formed, pre vi ous re search has fo cused on the link be tween not fol low ing rec om men da tions and hospi tal iza tion, ei ther for most of risk fac tors [14,24,31,33], or only some of them: expo sure to al ler gens [18], res pi ra to ry in fections [21], so ciode mo graph ic fac tors and de gree of sever i ty [7,14], man age ment and psy cho so cial fac tors [2], med i cal care [36], self-care [19], type of treat ment pre scribed [17,40,44], and ed u ca tion pro grams [15,28,45]. Asth ma costs have also been calcu lat ed, in clud ing the costs linked to hospi tal iza tion [8,9,39] and costs based on de gree of sever i ty [5,10,11,20] or in ten sity of med i cal con trol [42].…”

Section: Discussionmentioning

confidence: 99%

Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations

et al. 2005

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This prospective study of 169 adult patients hospitalized for severe acute asthma in four pneumology wards compared the incidence and costs of patients who were managed (group A) or not managed (group P) before hospitalization, according to the guidelines and international recommendations (11 criteria judged by experts). Ambulatory costs were calculated by questioning patients. Valuation of hospital costs was based DRGs weighted by length of stay. The incidence in group P patients was estimated at 70%; A patients were 14 years younger than those in group P and had less severe asthma. Their annual ambulatory care prior to hospitalization was less costly irrespective of age category or degree of severity (euro 685 vs. euro 1,145 in group A); their length of hospital stay was shorter (6.03 vs. 10.78 days), resulting in a lower cost of hospitalization (euro 2,820 vs. euro 4,843). In group P a specific education program based on increased understanding, compliance, self-management, and smoking cessation, particularly in young patients should lead to reductions in hospitalizations.

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Section: Discussionmentioning

confidence: 99%

Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations

et al. 2005

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“…Inhaled corticosteroids are the linchpin of preventive therapy in adult asthma; these agents modulate the inflammatory response in airways,46-49 reduce the level of airway responsiveness,50-52 improve various parameters of asthma control,52-54 and reduce asthma morbidity 555…”

Section: Discussionmentioning

confidence: 99%

Case-control study of severe life threatening asthma (SLTA) in adults: demographics, health care, and management of the acute attack

Kolbe

2000

Thorax

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Background-Severe life threatening asthma (SLTA) is important in its own right and as a proxy for asthma death. In order to target hospital based intervention strategies to those most likely to benefit, risk factors for SLTA among those admitted to hospital need to be identified. A case-control study was undertaken to determine whether, in comparison with patients admitted to hospital with acute asthma, those with SLTA have diVerent sociodemographic and clinical characteristics, evidence of inadequate ongoing medical care, barriers to health care, or deficiencies in management of the acute attack. Methods-Seventy seven patients with SLTA were admitted to an intensive care unit (pH 7.17 (0.15), PaCO 2 10.7 (5.0) kPa) and 239 matched controls (by date of index attack) with acute asthma were admitted to general medical wards. A questionnaire was administered 24-48 hours after admission. Results-The risk of SLTA in comparison with other patients admitted with acute asthma increased with age (odds ratio (OR) 1.04/year, 95% CI 1.01 to 1.07) and was less for women (OR 0.36, 95% CI 0.20 to 0.68). These variables were controlled for in all subsequent analyses. There were no diVerences in other sociodemographic features. Cases were more likely to have experienced a previous SLTA (OR 2.04, 95% CI 1.20 to 3.45) and to have had a hospital admission in the last year (OR 1.86, 95% CI 1.09 to 3.18). There were no diVerences between cases and controls in terms of indicators of quality of ongoing asthma specific medical care, nor was there evidence of disproportionate barriers to health care. During the index attack cases had more severe asthma at the time of presentation, were less likely to have presented to general practitioners, and were more likely to have called an ambulance or presented to an emergency department. In terms of pharmacological management, those with SLTA were more likely to have been using oral theophylline (OR 2.14, 95% CI 1.35 to 3.68) and less likely to have been using inhaled corticosteroids in the two weeks before the index attack (OR 0.69, 95% CI 0.47 to 0.99). While there was no diVerence in selfmanagement knowledge or behaviour scores, those with SLTA were more likely to have inappropriately used oral corticosteroids during the acute attack (OR 2.09, 95% CI 1.02 to 4.47). Conclusions-In comparison with those admitted to hospital with acute severe asthma, patients with SLTA were indistinguishable on sociodemographic criteria (apart from male predominance), were more likely to have had a previous SLTA or hospital admission in the previous year, had similar quality ongoing asthma care, had no evidence of increased physical, economic or other barriers to health care, but had demonstrable deficiencies in the management of the acute index attack. Educational interventions, while not losing sight of the need for good quality ongoing care, should focus on providing individual patients with better advice on self-management of acute exacerbations.

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“…One explanation for this is that asthma sufferers do not take medication as prescribed [4,5]. Adherence to prescribed regimens of inhaled corticosteroids have been shown to decrease the risk of hospitalisation [6] and death due to asthma [7]. Many GP practices have established asthma clinics and a great deal of effort has been invested in the education of patients regarding the management of asthma [8,9].…”

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confidence: 99%

What predicts poor collection of medication among children with asthma? A case-control study

Irvine¹,

Crombie²,

Alder³

et al. 2002

Eur Respir J

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Compliance with asthma medication is recognised to be a problem. Acquisition of medication is the first step towards compliance. Factors predicting poor collection of prophylactic medication were investigated.A case/control study was conducted. Cases were children who had had at least two consultations for poorly controlled asthma in 1 yr and collected prescriptions of prophylactic medication irregularly. Controls were children whose prescriptions were collected as instructed.Levels of knowledge about asthma and asthma medication were high in both groups. Parents of cases were more likely to perceive their child's asthma to be moderate or severe and more likely to report that their child's asthma was not well controlled. They reported more night-time symptoms, exercise symptoms and school absence. Parents of cases were less likely to report that administering inhalers was part of the evening routine. They were less likely to perceive their child's prophylactic medication to be very effective and more reluctant to administer prophylactic medication.Some parents may decide to undertreat their children, although lack of organised routine may contribute to poor compliance. Parents need guidance on interpreting symptoms and support in establishing routines for the administration of medication.

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Inhaled Steroids and the Risk of Hospitalization for Asthma

Abstract: Inhaled steroids and, to a lesser extent, cromolyn confer significant protection against exacerbations of asthma leading to hospitalization. These results support the use of inhaled steroids by individuals who require more than occasional beta-agonist use to control asthma symptoms.

Cited by 397 publications

References 23 publications

Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations

Costs of hospitalization for severe acute asthma of patients not treated according to guidelines and recommendations

Case-control study of severe life threatening asthma (SLTA) in adults: demographics, health care, and management of the acute attack

What predicts poor collection of medication among children with asthma? A case-control study

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