Coyle YM, Aragaki CC, Hynan LS, Gruchalla RS, Khan DA. Arch Intern Med. 2003;163:1591–1596
Purpose of the Study.
To identify processes of asthma care that result in improved peak expiratory flow rate (PEFR) 2 to 3 weeks after an emergency department visit.
A total of 365 adults with asthma who were discharged from a public hospital emergency department after an asthma exacerbation were studied.
Eligible patients were identified from an administrative database and were invited for a follow-up visit 2 to 3 weeks after discharge from the emergency department. Information regarding 6 processes of care was obtained from emergency department records and questionnaires. These processes of care were 1) inhaled β-receptor agonist at discharge, 2) inhaled corticosteroids at discharge, 3) systemic corticosteroids, 4) a follow-up visit, 5) patient education regarding an inhaler device, and 6) patient education regarding asthma medication use. Each process was examined as a potential predictor of percentage changes in predicted PEFR.
Three hundred sixty-five of 448 eligible patients enrolled in the study, and 309 returned for the follow-up visit. The study population was economically disadvantaged and predominantly African American and Hispanic. The range of percentage PEFR changes was −165% to 590%, with a median of 80%. Male subjects had significantly greater percentage PEFR changes than did female subjects (115% vs 74%, P = .002), and patients with mild asthma had significantly greater percentage PEFR changes than did those with moderate or severe asthma (148% vs 87% and 22%, respectively; P < .001). After adjustment for gender, ethnicity, and asthma severity, appropriate use of systemic corticosteroids at discharge was associated with a 31.6% increase in the predicted PEFR (95% confidence interval: 8.1–55.1%). Asthma severity did not modify the effect of systemic corticosteroids on percentage changes in PEFR.
These findings suggested that, among poor minority adults with asthma, systemically administered corticosteroids improved PEFR 2 to 3 weeks after discharge from an emergency department.
Although the results were not surprising, this study demonstrated that at least 1 aspect of acute asthma care might have improved outcomes in a high-risk patient population. Whether the improvements in PEFR seen a few weeks after discharge represent markers for improved asthma outcomes in the longer term remains to be determined.