PEDIATRICS Vol. 107 No. 4 April 2001, pp. 706-711
Impact of Inhaled Antiinflammatory Therapy on Hospitalization and Emergency Department Visits for Children With Asthma
Received Mar 17, 2000; accepted Aug 3, 2000.
,
, and
From the * Channing Laboratory, Brigham & Women's Hospital,
Harvard Medical School, Boston, Massachusetts; the Department of
Ambulatory Care and Prevention, Harvard Medical School and Harvard
Pilgrim Health Care, Boston, Massachusetts; the § Center for Health
Studies, Group Health Cooperative of Puget Sound and the Department of
Pediatrics, University of Washington, Seattle, Washington; and the
Center for Health Services Research, Rush Primary Care Institute,
Chicago, Illinois.
Objective. Although the efficacy of inhaled antiinflammatory therapy in improving symptoms and lung function in childhood asthma has been shown in clinical trials, the effectiveness of these medications in real-world practice settings in reducing acute health care use has not been well-evaluated. This study examined the effect of inhaled antiinflammatory therapy on hospitalizations and emergency department (ED) visits by children for asthma.
Design. Defined population cohort study over 1 year.
Setting. Three managed care organizations (MCOs) in Seattle, Boston, and Chicago participating in the Pediatric Asthma Care-Patient Outcome Research and Treatment II trial.
Participants. All 11 195 children, between 3 to 15 years old, with a diagnosis of asthma who were enrolled in the 3 MCOs between July 1996 and June 1997.
Outcome Measures. We identified children with 1 or more asthma diagnoses using automated encounter data. Medication dispensings were identified from automated pharmacy data. Multivariate logistic regression analysis was used to calculate effects of inhaled antiinflammatory therapy on the adjusted relative risk (RR) for hospitalization and ED visits for asthma.
Results. Over 12 months, 217 (1.9%) of children had an
asthma hospitalization, and 757 (6.8%) had an ED visit. After
adjustment for age, gender, MCO, and reliever dispensing, compared with
children who did not receive controllers, the adjusted RRs for an ED
visit were: children with any (
1) dispensing of cromolyn, 0.4 (95% confidence interval [CI]: 0.3, 0.5); any inhaled corticosteroid (ICS), 0.5 (95% CI: 0.4, 0.6); any cromolyn or ICS combined (any controller), 0.4 (95% CI: 0.3, 0.5). For hospitalization, the adjusted
RR for cromolyn was 0.6 (95% CI: 0.4, 0.9), for ICS 0.4 (95% CI: 0.3, 0.7), and for any controller 0.4 (95% CI: 0.3, 0.6). A significant
protective effect for both events was seen among children with 1 to 5 and with >5 antiinflammatory dispensings. When the analysis was
stratified by frequency of reliever dispensing, there was a significant
protective effect for controllers on ED visits for children with 1 to 5 and with >5 reliever dispensings and on the risk of hospitalization
for children with >5 reliever dispensings.
Conclusions. Inhaled antiinflammatory therapy is associated with a significant protective effect on the risk for hospitalization and ED visits in children with asthma. Cromolyn and ICSs were associated with similar effects on risks.asthma drug therapy, inhaled antiinflammatory agents, health maintenance organizations, hospitalization, emergency department. .
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