PURPOSE:In children, hospitalization for asthma is reported to have a distinct seasonal pattern with peaks coincident with school start. Although guidelines indicate asthma controller medications should be used daily, there is limited information on patterns of medication use and corresponding healthcare utilization.
METHODS:An epidemiologic analysis was conducted using data from the United Healthcare database for children 2–12 years old during 2002–2004. Patterns of healthcare utilization and estimates of prescription asthma controller and reliever use were determined. Rates were constructed by week; deviations from annual mean rates were analyzed. Results were confirmed using Poisson regression models, modeling rates within age group (2–5 and 6–12), with factors for week, year, and region.
RESULTS:Utilization of healthcare services was minimal during summer; September consistently served as a point of inflection for both age groups; peaks occurred in October or November (Weeks 40–46). Peak ED visits for the 2 age groups were approximately 2.4 to 2.8 times higher; outpatient visits were approximately 3.1 to 3.3 times higher; and hospitalizations were approximately 3.7 to 5.6 times higher than the model-adjusted low mean value at Week 27 (July). Asthma controller and reliever medications claims increased beginning in September (Week 37), peaking in December (Week 51). Peaks for controller medications were 1.5 to 1.9 times higher and peaks for reliever medications were 2.5 to 3.4 times higher than the annual low mean value. Rates for healthcare use and claims for asthma medications also were elevated in February (approximately Week 7).
CONCLUSION:The distinct seasonal peaks in healthcare utilization followed by peaks in asthma medication claims suggest that children who reduce their medications do not resume taking them until their symptoms worsen.
CLINICAL IMPLICATIONS:Intermittent courses of asthma controller medications for children before the start of fall or at other times of predicted asthma outbreaks may prove beneficial, rather than waiting until symptoms appear.
DISCLOSURE:Kristen Levine, Shareholder Authors Swern and Nelsen may own stock and/or hold stock options in the sponsor company; Employee Authors Swern and Nelsen are employees of the sponsor company.; Other Author Levine is supported by a Merck Foundation fellowship.; No Product/Research Disclosure Information