Children with persistent asthma who use fewer inhaled antiinflammatory (AI) medications are more likely to end up in the emergency department (ED) or be hospitalized for asthma-related breathing problems than children who more regularly use these "controllers," according to a new study. The researchers, who were supported in part by the Agency for Healthcare Research and Quality (HS09935), found that children with persistent asthma who were dispensed AI medication one to three times during the study year had a greater risk of hospital-based events than those with six or more AI dispensings.
The researchers interviewed parents of children enrolled in five Medicaid managed care plans at baseline and 1-year later and determined their health care and medication use from health plan claims data. They stratified children into three groups according to asthma severity: intermittent asthma; persistent asthma with infrequent (three or fewer times a year) dispensing of beta-agonist (BA) "rescue" medication (adrenaline-like medication that quickly opens up the airways); and persistent asthma with frequent BA dispensing (four or more times per year).
Of the 1,504 children studied, 3 percent were hospitalized, and 9 percent visited the ED at least once for asthma during the baseline year. Of those 1,262 who remained in their health plans for 11 months or more during the followup year, 2 percent were hospitalized and 6 percent visited the ED at least once for asthma during the followup year.
In conclusion, the researchers note that more frequent dispensing of AI controller medication was associated with lower risk of having a hospital-based event for patients with the most severe persistent asthma, but it did not predict risk for these events during the followup year. The reasons for this negative finding are unclear. Further, there was no association among any of the inhaled AI medication dispensing measures and the clinical outcome measures in the subgroup with less severe, persistent asthma, but there may have been too few children who regularly used AI medication to detect an effect.
See "Use of asthma medication dispensing patterns to predict risk of adverse health outcomes: A study of Medicaid-insured children in managed care programs," by Harold J. Farber, M.D., Felicia W. Chi, M.P.H., Angela Capra, M.A., and others, in the March 2004 Annals of Allergy Asthma and Immunology 92, pp. 319-328.
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