Van Dole KB, Swern AS, Newcomb K, Nelsen L. Ann Allergy Asthma Immunol. 2009;102(3):198–204
PURPOSE OF THE STUDY. The goal of the study was to determine how seasonal patterns of asthma medication prescription claims relate to seasonal patterns of asthma-related health care use (outpatient visits, emergency department visits, and hospitalizations) for children.
STUDY POPULATION. Data were collected for preschool-aged children (2–5 years of age) and school-aged children (6–12 years of age).
METHODS. An ecological analysis of data from insurance claims records from 2002 through 2004 was conducted with a large US health care plan (United Healthcare) database. Patterns of health care use and estimates of prescription asthma controller and reliever use were determined. Controller medications were defined as inhaled corticosteroids, leukotriene receptor antagonists, and long-acting β2-adrenergic receptor agonists. Reliever medications were defined as short-acting β2-adrenergic receptor agonists only. Rates were constructed by week; deviations from annual mean rates were used to determine peaks in use.
RESULTS. Rates of emergency department visits, outpatient visits, and hospitalizations were lowest during summer months; rates increased beginning in September, peaking in October or November. Asthma controller and reliever medication claims increased beginning in September, peaking in December.
CONCLUSIONS. The data suggest that children who reduce their asthma medications during the summer do not resume taking asthma medications until symptoms of asthma worsen. The summer hiatus and other factors may contribute to seasonal increases in health care use and in asthma medication prescriptions, particularly in the autumn.
REVIEWERS COMMENTS. It has been established that asthma-related health care use has a seasonal pattern, with a peak at the start of the school year. The authors found that, coincident with increased health care use, there is an increase in prescription claims for asthma medications. The authors hypothesize that this may be because a summer medication hiatus is taken. Although this is an intriguing possibility, additional study needs to be performed to determine support for a causal relationship, because many seasonal factors play an important role in asthma exacerbations and rates of new asthma diagnoses. For patients with established asthma, controller medication claims should remain relatively steady throughout the year if the medications are being used on a chronic basis. The fact that there are peak periods when more claims for controller medications are filed supports the possibility that the medications are being prescribed in this manner or patients are using the controller medications on an as-needed basis. However, it is not surprising that reliever medication claims demonstrate a seasonal pattern. Limitations of the study are that this database represents only an insured population and it is not possible to determine actual use (or adherence to a prescribed regimen) of prescription medications from these data.
- Copyright © 2009 by the American Academy of Pediatrics