PURPOSE OF THE STUDY.
To identify factors associated with severe asthma exacerbations in children as measured by the number of emergency department (ED) visits and hospitalizations.
Asthmatic children aged 1 to 18 years were enrolled from specialty and family practice hospital-based outpatient clinics and 2 EDs in Ontario, Canada, from November, 1, 2000, through March 31, 2003.
Data regarding demographics, socioeconomic status, drug plan characteristics, health status, health utilization, and symptom data were collected during this retrospective cohort study. These data were compared with data on asthma ED visits and hospitalizations in the full group and a subgroup with prescription drug coverage.
Complete data were available from 490 patients. Fewer exacerbations were associated with medium/high income, older children, recruitment from a physician's office or asthma clinic, and having an action plan. Previous ED visits, pet ownership, nebulizer use, asthma education, and younger age were associated with more exacerbations. A history of food, medication, and insect allergies were associated with 52% more exacerbations. In the drug-plan subgroup, girls had 26% fewer exacerbations, and the rate of asthma exacerbations increased by 14% for every 1% increase in the proportion of income spent on prescription medicines.
Exacerbations that required urgent care were associated with asthma history, disease-management factors, and socioeconomic status. Because families with drug plans paid a higher proportion of household income for asthma medicines, there was a significant association with more exacerbations.
This study demonstrates what clinicians see in clinical practice: cost-shifting often leads to rationing and underuse of needed medicines by our patients. We need to assess medication use and educate and assist families in understanding the rationale for a particular medication regimen to increase compliance and decrease exacerbations.
- Copyright © 2011 by the American Academy of Pediatrics