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Nonprescription Bronchodilator Medication Use in Asthma

Ware G. Kuschner; Todd C. Hankinson; Hofer H. Wong; Paul D. Blanc
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Affiliations: From the Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco,  From the Middlebury College, Middlebury, Vt.,  From the Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco

Affiliations: From the Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco,  From the Middlebury College, Middlebury, Vt.,  From the Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco

Affiliations: From the Divisions of Occupational and Environmental Medicine and Pulmonary and Critical Care Medicine, Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco,  From the Middlebury College, Middlebury, Vt.,  From the Department of Medicine, and the Cardiovascular Research Institute, University of California San Francisco


1997 by the American College of Chest Physicians


Chest. 1997;112(4):987-993. doi:10.1378/chest.112.4.987
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Abstract

Study objective: Many persons with asthma self-medicate with widely available and potentially hazardous nonprescription medicines. This study assessed the demographic and clinical covariates of self-treatment with over-the-counter asthma medications (OTCs).

Design and setting: We conducted an analytical investigation using questionnaires and measures of lung function, comparing OTC and prescription medication users. We recruited adults with asthma by public advertisement.

Subjects: We studied 22 exclusive prescription asthma medication users, 15 exclusive OTC users, and 13 other subjects who combined prescription medication use with self-treatment with asthma OTCs. All but one OTC user self-medicated with a nonselective, sympathomimetic metered-dose inhaler.

Results: Taking income, access to care, and self-assessed disease severity into account, male gender was strongly associated with exclusive OTC use alone (odds ratio [OR]=8.9, 95% confidence interval [CI]=1.3 to 61) and mixed OTC-prescription medication use (OR=9.7, 95% CI=1.1 to 83). The covariates of income, access to care, and self-assessed disease severity provided significant additional explanatory power to the model of exclusive OTC use (model χ2 difference 11.3, 5 df, p<0.05). Pulmonary function was similar among OTC and prescription medication users. However, prescription medication users' self-assessed asthma severity (mild compared to more severe) was associated with postbronchodilator reversibility of FEV1 obstruction (6% vs 18% reversibility, p<0.05) while exclusive OTC users' self-assessed severity showed the reverse pattern (19% vs 8%, p=0.2).

Conclusion: Asthma education programs attempting to discourage unregulated bronchodilator use should give consideration to this profile of the "asthmatic-at-risk."


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