There are 2 million asthma related emergency department events (ED) each year in the US. Under recognition and under treatment may be associated with this high rate. This study describes patterns of asthma care before and after asthma ED.
Retrospective observational study utilizing the PharMetrics Integrated Outcomes Database containing medical and pharmacy claims of ≥ 20 managed care plans. Patients with an asthma ED visit (primary ICD-9 493.xx) during 2001 were identified. Patients excluded with ≥ 1 asthma-related ED or hospitalization 1 year prior to the index ED. Asthma related pharmacy and medical claims were studied in the 12 months prior to and 2 months after the ED.
12,636 patients were identified. Twelve months prior to the index ED, patients used short-acting beta-agonist (SABA) and inhaled corticosteroid (ICS) at a 3:1 ratio. A total of 24.5% had ≥ 1 ICS claim (mean claims, 0.7/yr) and 53.5% had ≥ 1 SABA claim (2.2/yr), while 29.9% had ≥ 1 oral corticosteroid (OCS) claim (0.59/yr). Also, 93.6% had ≥ 1 office visit in the year prior but only 11.2% had ≥ 1 spirometry test. ICS claims increased 2.4 fold while OCS increased 6.8 fold the month immediately after the ED, returning to pre event levels 2 months after. Only 13.2% of patients not on ICS prior to the event received an ICS within 2 months after the event.
ICS containing treatments reduce exacerbations and ED visits. This study demonstrates that patients at risk for ED are not frequently assessed with spirometry and use 3 times more SABA than ICS. In addition, nearly 75% of patients were not receiving an ICS containing medication 1 year prior to the ED and the ED visits did not result in a substantial increase in the percent of patients using ICS.
The use of ICS and spirometry is underutilized in asthmatics at risk for a ED. Emphasis should be on improving asthma care, especially post ED discharge
D.A. Stempel, Received monies from GlaxoSmithKline, Industry.