Asthma Healthcare Utilization Research Articles

Impact of Physician Asthma Care Education on Patient Outcomes

We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program.

The effects of indoor environmental exposures on pediatric asthma: a discrete event simulation model.

BackgroundIn the United States, asthma is the most common chronic disease of childhood across all socioeconomic classes and is the most frequent cause of hospitalization among children. Asthma exacerbations have been associated with exposure to residential indoor environmental stressors such as allergens and air pollutants as well as numerous additional factors. Simulation modeling is a valuable tool that can be used to evaluate interventions for complex multifactorial diseases such as asthma but in spite of its flexibility and applicability, modeling applications in either environmental exposures or asthma have been limited to date.MethodsWe designed a discrete event simulation model to study the effect of environmental factors on asthma exacerbations in school-age children living in low-income multi-family housing. Model outcomes include asthma symptoms, medication use, hospitalizations, and emergency room visits. Environmental factors were linked to percent predicted forced expiratory volume in 1 second (FEV1%), which in turn was linked to risk equations for each outcome. Exposures affecting FEV1% included indoor and outdoor sources of NO2 and PM2.5, cockroach allergen, and dampness as a proxy for mold.ResultsModel design parameters and equations are described in detail. We evaluated the model by simulating 50,000 children over 10 years and showed that pollutant concentrations and health outcome rates are comparable to values reported in the literature. In an application example, we simulated what would happen if the kitchen and bathroom exhaust fans were improved for the entire cohort, and showed reductions in pollutant concentrations and healthcare utilization rates.ConclusionsWe describe the design and evaluation of a discrete event simulation model of pediatric asthma for children living in low-income multi-family housing. Our model simulates the effect of environmental factors (combustion pollutants and allergens), medication compliance, seasonality, and medical history on asthma outcomes (symptom-days, medication use, hospitalizations, and emergency room visits). The model can be used to evaluate building interventions and green building construction practices on pollutant concentrations, energy savings, and asthma healthcare utilization costs, and demonstrates the value of a simulation approach for studying complex diseases such as asthma.

Asthma outcomes: Healthcare utilization and costs

Measures of healthcare utilization and indirect impact of asthma morbidity are used to assess clinical interventions and estimate cost. National Institutes of Health institutes and other federal agencies convened an expert group to propose standardized measurement, collection, analysis, and reporting of healthcare utilization and cost outcomes in future asthma studies. We used comprehensive literature reviews and expert opinion to compile a list of asthma healthcare utilization outcomes that we classified as core (required in future studies), supplemental (used according to study aims and standardized), and emerging (requiring validation and standardization). We also have identified methodology to assign cost to these outcomes. This work was discussed at an National Institutes of Health-organized workshop in March 2010 and finalized in September 2011. We identified 3 ways to promote comparability across clinical trials for measures of healthcare utilization, resource use, and cost: (1) specify the study perspective (patient, clinician, payer, and society); (2) standardize the measurement period (ideally 12 months); and (3) use standard units to measure healthcare utilization and other asthma-related events. Large clinical trials and observational studies should collect and report detailed information on healthcare utilization, intervention resources, and indirect impact of asthma, so that costs can be calculated and cost-effectiveness analyses can be conducted across several studies. Additional research is needed to develop standard, validated survey instruments for collection of provider-reported and participant-reported data regarding asthma-related health care.

Trends in Asthma Healthcare Utilization in Southern Nevada

Trends in Asthma Healthcare Utilization in Southern Nevada

Trends in Asthma Healthcare Utilization in Southern Nevada

RATIONALE: Asthma morbidity affects an estimated 34 million individuals. In Nevada, the lifetime asthma prevalence rate for children and adults is 11.8% and 13.4%, respectively. Preliminary studies suggest that children and minorities are over-represented among asthmatics. Our aim was to study trends in asthma inpatient hospitalizations and emergency room (ER) visits at University Medical Center of Southern Nevada (UMC) (county teaching hospital). METHODS: Data on all asthmatics seen at the ER and admitted to UMC and total numbers of patients seen at UMC (2000-2007) were obtained in electronic form from UMC. Data were analyzed by the Chi-square test for trend, Analysis of Covariance and simple linear regression. RESULTS: Data were available for 16,500 asthmatics. 69% were of minority race, 54% male, 38% uninsured, and 60% <18 years of age. Asthma admission decreased from 2.7 to 1.8% of total admissions (X2= 34.784, p < 0.05) across time. Asthma ER visits increased from 2.3 to 2.6% of all ER visits (X2 = 8.380, p < 0.05). Increased ER utilization was seen for minority subgroups, males, and asthmatics <18 years. Uninsured patients decreased ER utilization initially, followed by a marked increase between years 2003-2007. CONCLUSIONS: Fewer patients were admitted to UMC for asthma care across time, yet ER utilization significantly increased. ER utilization was higher among children, minority groups, uninsured and males. Inadequate access to care and low income along with poor management and education may be contributors. Asthma education efforts and improved healthcare access in Southern Nevada are necessary for high risk populations to reduce seeking asthma treatment in the ER.

Patterns of Health Care Utilization for Asthma Treatment in Adults with Substance Use Disorders

: National goals for improving asthma outcomes include decreasing emergency room utilization and increasing adherence to outpatient treatment guidelines. Few studies have examined the impact of substance use disorders on asthma treatment. The objective of this study was to describe correlations between substance use disorders and patterns of healthcare utilization for asthma care. : We performed a retrospective analysis of 1999 Medicaid claims for adults with asthma from 5 states. Adjusted odds of receiving asthma treatment in outpatient, inpatient, and emergency settings were calculated for patients with substance use disorder (SUD). : Consistent patterns emerge demonstrating significantly lower odds of utilization of outpatient services for asthma in patients with SUD. A trend toward increased utilization of acute care resources was observed, with odds of emergency care for asthma significantly increased in New Jersey (odds ratio [OR], 1.14; 95% confidence interval [CI], 1-1.31) and Georgia (OR, 1.24; 95% CI, 1.04-1.48), and odds of inpatient care for asthma significantly increased in Georgia (OR, 1.42; 95% CI, 1.03-1.95). : Substance use disorders are associated with decreased odds of receiving outpatient care and equivalent or increased odds of receiving emergency and inpatient care for asthma. Consequently, outpatient-based strategies to improve asthma care may have a very limited impact for this population. Identifying asthma patients with SUD in acute care settings and enhancing the care they receive in these settings may be necessary to improve adherence to treatment guidelines and decrease utilization in this population.

Elevated Ambient Air Zinc Increases Pediatric Asthma Morbidity

BackgroundRecent studies indicate that the composition of fine particulate matter [PM ≤ 2.5 μm in aerodynamic diameter (PM2.5)] is associated with increased hospitalizations for cardiovascular and respiratory diseases. The metal composition of PM2.5 influences allergic and/or inflammatory reactions, and ambient zinc contributes to worsening pulmonary function in susceptible adults. However, information is limited concerning associations between ambient air zinc levels and health care utilization for asthma, especially among children.ObjectiveWe aimed to investigate the relationship between outdoor ambient air PM2.5 zinc levels and urgent health care utilization for children living in an urban area.MethodsWe used a time-series study to estimate the association of ambient air PM2.5 zinc levels with hospital admissions and emergency department (ED) utilization by children in Baltimore, Maryland, controlling for time trends. We used data from daily discharge administrative claims of ED and hospital utilization for asthma in children, 0–17 years of age for Greater Baltimore from June 2002 through November 2002. We collected ambient air PM2.5 metal concentration data, determined by X-ray fluorescence spectroscopy, during the U.S. Environmental Protection Agency–sponsored Baltimore Supersite project.ResultsPrevious-day medium levels of zinc (8.63–20.76 ng/m3) are associated with risks of pediatric asthma exacerbations that are 1.23 (95% confidence interval, 1.07–1.41) times higher than those with previous-day low levels of zinc (< 8.63 ng/m3) after accounting for time-varying potential confounders.ConclusionResults suggest that high ambient air PM2.5 zinc levels are associated with an increase in ED visits/hospital admissions for asthma on the following day among children living in an urban area.

Health-Care Use Among Puerto Rican and African-American Children With Asthma

To compare the rates of emergency department (ED) visits, hospitalizations, hospital days, and outpatient clinic visits for asthma among children in two ethnic minority groups that are disproportionately affected by asthma (Puerto Ricans and African Americans).This cross-sectional study was part of an asthma intervention program in Hartford, CT, in which 6,554 children were screened for asthma by primary care providers using a parental survey. Medicaid and the supplementary State Children's Health Insurance Plan data about health-care utilization for asthma were obtained for each child for the 12 months preceding completion of the screening survey.Among 2,304 children in whom asthma had been diagnosed, Puerto Ricans had more severe asthma than African Americans. In analyses adjusted for asthma severity and other potential confounders, Puerto Rican children had more clinic visits for asthma (rate ratio [RR], 1.31; 95% confidence interval [CI], 1.12 to 1.53) but spent fewer days in the hospital for asthma (RR, 0.36; 95% CI, 0.24 to 0.53) than African-American children. There were no differences in the rates of ED visits or hospitalizations between the two groups.Puerto Rican children had more severe asthma but were less likely than African-American children to have prolonged hospitalizations for asthma. This finding may be due to the frequent clinic visits for asthma made by Puerto Rican children. Further research is needed to understand the cultural factors that contribute to different approaches to health-care utilization among ethnic minorities.

Impact of Physician Asthma Care Education on Patient Outcomes

We evaluated the effectiveness of a continuing medical education program, Physician Asthma Care Education, in improving pediatricians' asthma therapeutic and communication skills and patients' health care utilization for asthma. We conducted a randomized trial in 10 regions in the United States. Primary care providers were recruited and randomly assigned by site to receive the program provided by local faculty. The program included 2 interactive seminar sessions (2.5 hours each) that reviewed national asthma guidelines, communication skills, and key educational messages. Format included short lectures, case discussions, and a video modeling communication techniques. We collected information on parent perceptions of physicians' communication, the child's asthma symptoms, and patients' asthma health care utilization. We used multivariate regression models to determine differences between control and intervention groups. A total of 101 primary care providers and a random sample of 870 of their asthma patients participated. After 1 year, we completed follow-up telephone interviews with the parents of 731 of the 870 patients. Compared to control subjects, parents reported that physicians in the intervention group were more likely to inquire about patients' concerns about asthma, encourage patients to be physically active, and set goals for successful treatment. Patients of physicians that attended the program had a greater decrease in days limited by asthma symptoms (8.5 vs 15.6 days), as well as decreased emergency department asthma visits (0.30 vs 0.55 visits per year). The Physician Asthma Care Education program was used in a range of locations and was effective in improving parent-reported provider communication skills, the number of days affected by asthma symptoms, and asthma health care use. Patients with more frequent asthma symptoms and higher health care utilization at baseline were more likely to benefit from their physician's participation in the program.

Using an Asthma Control Questionnaire and Administrative Data To Predict Health-Care Utilization

To examine the merits of the Asthma Therapy Assessment Questionnaire (ATAQ) control index together with prior asthma health-care utilization from administrative data in predicting future acute asthma health-care utilization. Prospective cohort study. A total of 4,788 adult asthma patients aged 17 to 93 years who completed a baseline evaluation and had at least 6 months of follow-up data. Classification and regression tree methodology to predict future risk of acute health-care utilization events. These results show that the ATAQ control index and administrative data are jointly useful for predicting future health-care utilization. The utility of the ATAQ control index in the presence of information about prior health-care utilization is to further stratify risk among the subset of younger individuals who did not have any prior acute health-care utilization. While administrative health-care utilization data served as the strongest predictor of future health-care utilization, the ATAQ control index helped to identify 1% of individuals without recent acute care that had approximately a sixfold elevated risk (95% confidence interval, 4.2 to 8.4) of future acute health-care utilization. This is an important result since only a small fraction of individuals with acute events in a given year will have had acute events in the previous year. These findings should assist the practicing clinician and organizations interested in population-based asthma disease management.

Airway Hyperresponsiveness to Methacholine at Age 6 to 8 Years in Nonasthmatic Patients Is Not Related to Increased Health-Care Utilization for Asthma in the Ensuing 5 Years: A Longitudinal Study of a Birth Cohort

Children with heightened airway responsiveness have a greater tendency to develop asthma symptoms. Many existing studies describing this relationship have relied on self-reported symptoms that may be prone to recall bias. In addition, few studies have examined the relationship of airway hyperresponsiveness (AHR) to indicators of asthma severity such as health-care utilization. To determine whether a positive response to methacholine challenge in children without current or physician-diagnosed asthma at age 6 to 8 years is predictive of the subsequent onset of asthma requiring medical evaluation or treatment in the ensuing 5 years. Data were obtained from subjects in a population-based birth cohort (n = 835) enrolled from 1987 to 1989, who were members of a large medical group practice component of a health maintenance organization (HMO). We analyzed a subset of subjects (n = 245) who had completed a methacholine challenge at age 6 to 8 years, had no current or physician-diagnosed asthma, and were still served by the same medical group. These children were followed up from the time of methacholine challenge until HMO disenrollment or through June 2001 (ages 11 to 13 years), whichever came first. Pharmacy claims data and diagnostic codes from physician-patient encounters were evaluated for incident asthma. Incident cases of clinical asthma were defined as any child with two outpatient visits or one hospitalization, one emergency department encounter associated with an asthma diagnostic code (ie, 493.XX), or any child filling prescriptions for two bronchodilators or one antiinflammatory asthma medicine. Methacholine responsiveness was interpreted using American Thoracic Society criteria. Asthma incidence did not differ based on methacholine challenge results for children with normal, borderline, and mild AHR. No child in the study demonstrated moderate-to-severe AHR. Our data suggest that AHR with a borderline or weakly positive result in a methacholine challenge in children 6 to 8 years old without current or physician-diagnosed asthma is not related to increased health-care utilization for asthma in the ensuing 5 years.

Using the ecology model to describe the impact of asthma on patterns of health care.

BackgroundAsthma changes both the volume and patterns of healthcare of affected people. Most studies of asthma health care utilization have been done in selected insured populations or in a single site such as the emergency department. Asthma is an ambulatory sensitive care condition making it important to understand the relationship between care in all sites across the health service spectrum. Asthma is also more common in people with fewer economic resources making it important to include people across all types of insurance and no insurance categories. The ecology of medical care model may provide a useful framework to describe the use of health services in people with asthma compared to those without asthma and identify subgroups with apparent gaps in care.MethodsThis is a case-control study using the 1999 U.S. Medical Expenditure Panel Survey. Cases are school-aged children (6 to 17 years) and young adults (18 to 44 years) with self-reported asthma. Controls are from the same age groups who have no self-reported asthma. Descriptive analyses and risk ratios are placed within the ecology of medical care model and used to describe and compare the healthcare contact of cases and controls across multiple settings.ResultsIn 1999, the presence of asthma significantly increased the likelihood of an ambulatory care visit by 20 to 30% and more than doubled the likelihood of making one or more visits to the emergency department (ED). Yet, 18.8% of children and 14.5% of adults with asthma (over a million Americans) had no ambulatory care visits for asthma. About one in 20 to 35 people with asthma (5.2% of children and 3.6% of adults) were seen in the ED or hospital but had no prior or follow-up ambulatory care visits. These Americans were more likely to be uninsured, have no usual source of care and live in metropolitan areas.ConclusionThe ecology model confirmed that having asthma changes the likelihood and pattern of care for Americans. More importantly, the ecology model identified a subgroup with asthma who sought only emergent or hospital services.

Parents’ Management of Asthma Triggers

Allergy and Immunology| November 01 2004 Parents’ Management of Asthma Triggers AAP Grand Rounds (2004) 12 (5): 58–59. https://doi.org/10.1542/gr.12-5-58-a Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Parents’ Management of Asthma Triggers. AAP Grand Rounds November 2004; 12 (5): 58–59. https://doi.org/10.1542/gr.12-5-58-a Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: asthma management, precipitating factors Source: Cabana MD, Slish KK, Lewis TC, et al. Parental management of asthma triggers within a child’s environment. J All Clin Immunol. 2004;114:352–357. This study from the University of Michigan, Ann Arbor, assessed parental attempts to decrease their children’s exposure to asthma triggers. Subjects were a random sample of 2- to 12-year-old children with asthma, identified from the patient panels of a convenience sample of 106 primary care practices from 10 geographic areas in the United States that were participating in a study of asthma health care utilization. Of 1,077 eligible patients, 896 (83%) completed interviews. In response to open-ended questions, parents identified triggers to their children’s asthma and the steps taken to eliminate those triggers. The authors categorized the types of triggers and actions taken. Each possible action was coded as either recommended (consistent with the National Heart, Lung, and Blood Institute [NHLBI] Guidelines1), reasonable (thought by some clinicians to be helpful but without supporting evidence), neutral (no known positive or negative effects), or not recommended (harmful or discouraged by the NHLBI Guidelines). Respondents identified a mean of 2.2 ± 1.7 triggers (range 0–9) and took an average of 2 ± 1.6 actions (range 0–9). Of the 717 (80%) who identified at least 1 trigger, 135 (19%) did not attempt to decrease trigger exposure. The remainder (582, 81%) took an average of 3 actions per family. The most common actions included purchasing an air filter (25%), reducing dust exposure (22%), purchasing specialized vacuums and bedding (17%), increasing house cleaning (13%), and reducing animal exposure (11%). Fifty-one percent of actions were not likely to be useful (neutral), given the child’s known triggers. For example, only 70% of respondents who purchased an air filter had a child whose triggers would be reduced by using an air filter. Of 216 children (24%) living with a smoker, only 16 (7%) families attempted to decrease environmental tobacco smoke exposure. Forty-two percent of actions taken were consistent with NHLBI Guidelines. Only 1% of actions taken were not recommended. Multivariate analysis showed that receiving asthma education and an increased number of visits to the primary care physician were associated with an increased likelihood of taking at least 1 step toward trigger avoidance. For the 4 most common triggers (dust, animals, tobacco smoke, and mold), no demographic characteristic predicted which parents were more or less likely to take at least 1 recommended action to control exposure to that trigger. Trigger avoidance is an essential component of asthma care.1 Up to 90% of children with asthma have allergies,2 but non-specific irritant triggers (environmental tobacco smoke, viral infections, exercise, cold air) will affect all patients at some point. Complete avoidance of specific (allergic) and non-specific (irritant) triggers is impossible. For example, cat and dog dander are imported to the classroom on the clothing of pet owners, exposing those who do not own pets.3 However, reasonable attempts at avoidance should be made by every family with an asthmatic child. Treating... You do not currently have access to this content.

Effectiveness of a multicomponent self-management program in at-risk, school-aged children with asthma

Improving asthma knowledge and self-management is a common focus of asthma educational programs, but most programs have had little influence on morbidity outcomes. We developed a novel multiple-component intervention that included the use of an asthma education video game intended to promote adoption of asthma self-management behaviors and appropriate asthma care. To determine the effectiveness of an asthma education video game in reducing morbidity among high-risk, school-aged children with asthma. We enrolled 119 children aged 5 to 12 years from low-income, urban areas in and around San Francisco, CA, and San Jose, CA. Children with moderate-to-severe asthma and parental reports of significant asthma health care utilization were randomized to participate in the disease management intervention or to receive their usual care (control group). Patients were evaluated for clinical and quality-of-life outcomes at weeks 8, 32, and 52 of the study. Compared with controls, the intervention group had significant improvements in the physical domain (P = .04 and P = .01 at 32 and 52 weeks, respectively) and social activity domain (P = .02 and P = .05 at 32 and 52 weeks, respectively) of asthma quality of life on the Child Health Survey for Asthma and child (P = .02 at 8 weeks) and parent (P = .04 and .004 at 32 and 52 weeks, respectively) asthma self-management knowledge. There were no significant differences between groups on clinical outcome variables. A multicomponent educational, behavioral, and medical intervention targeted at high-risk, inner-city children with asthma can improve asthma knowledge and quality of life.

TRENDS IN CHILDHOOD ASTHMA: PREVALENCE, HEALTH CARE UTILIZATION, AND MORTALITY

Akinbami LJ, Schoendorf KC. Pediatrics. 2002;110:315–322The burden of asthma is larger for pediatric patients than for the rest of the population. The study objective was to assess changes in the burden of asthma among US children by providing a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality using national data.Data from the National Center for Health Statistics included children with asthma 0 to 17 years old from 1980 to the most recent year data were available.Asthma demographic data from the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics Survey were used to describe trends in childhood asthma. Children were stratified by age group (0–4 years, 5–10 years, and 11–17 years) and by race/ethnicity when possible.Childhood asthma prevalence increased from 3.6% to 6.2% (average increase of 4.3% per year) from 1980–1996. A peak prevalence of 7.5% occurred in 1995. The largest increase in prevalence (and associated greater health care use) was in the 0 to 4-year-old age group. Asthma prevalence comparing non-Hispanic blacks and non-Hispanic whites showed a higher prevalence for non-Hispanic blacks by 15% in 1980–1981 and 29% in 1995–1996. Asthma attack prevalence was 5.4% in 1996 and remained plateaued from 1997–2000. Comparison to years before 1997 are precluded by changes in the NHIS design. Asthma office visits grew 3.8% per year from 1989–1999 and hospitalization rates increased 1.4% per year from 1980–1998. Deaths from asthma increased by 3.4% per year from 1980–1998. The greatest mortality occurred in adolescents. Black children were >3 times as likely to be hospitalized and in 1997–1998 were >4 times as likely to die from asthma compared with white children throughout the study.The increasing burden in childhood asthma may finally be plateauing. The disparities between black children compared with white children remains quite significant for asthma health care utilization and mortality.Could the dramatic and concerning increases in childhood asthma seen over the last 2 decades finally be leveling off? Despite this suggested trend, asthma remains the most common chronic disease of childhood. The 1997 redesign of the NHIS makes following asthma trends somewhat difficult but does emphasize the importance of tracking changes in future years. Perhaps most concerning is the continued increase in hospitalizations and racial disparities. Continuing research efforts are being supported to determine the multifactorial causes of asthma inception in a variety of specific populations including inner-city children and high-risk atopic children.

Childhood wheezing syndromes and healthcare data.

There is convincing evidence that several distinct wheezing syndromes exist in childhood. The purpose of this research was to assess the potential of using healthcare utilization profiles to identify wheezing syndromes in children which are distinct from asthma. Using population-based healthcare administrative data, a cohort of children, aged 5-15 years, with bronchitis diagnoses from time of birth to 1995, but no physician diagnoses of asthma, was followed over the period January 1996-March 1998. In this follow-up period, 13% had subsequent healthcare utilization for asthma, 23% had continued healthcare utilization for bronchitis, and 64% had no further healthcare utilization. The likelihood of bronchitis vs. asthma outcomes was determined for a variety of asthma risk factors. In a cohort of 11,043 children with initial healthcare contact for bronchitis but not asthma, two potentially distinct entities of bronchitis emerged from our data: 1) transient bronchitis, similar to transient wheezing of early childhood, which was associated with winter-only healthcare utilization and absence of allergy, and 2) recurrent bronchitis which differed from asthma on the basis of winter-only healthcare utilization, prematurity at birth, absence of allergy, and low socioeconomic status. Healthcare administrative records can be used to describe the natural history of wheezing in children and to identify markers which may discriminate asthma from other syndromes.

Trends in childhood asthma: prevalence, health care utilization, and mortality.

Our objective was to use national data to produce a comprehensive description of trends in childhood asthma prevalence, health care utilization, and mortality to assess changes in the disease burden among US children. Five data sources from the National Center for Health Statistics were used to describe trends in asthma for children aged 0 to 17 years from 1980 to the most recent year for which data were available. These included the National Health Interview Survey (NHIS), the National Ambulatory Medical Care Survey, the National Hospital Ambulatory Medical Care Survey, the National Hospital Discharge Survey, and the Mortality Component of the National Vital Statistics System. Asthma prevalence increased by an average of 4.3% per year from 1980 to 1996, from 3.6% to 6.2%. The peak prevalence was 7.5% in 1995. In 1997, asthma attack prevalence was 5.4%, but changes in the NHIS design in 1997 preclude comparison to previous estimates. Asthma attack prevalence remained level from 1997 to 2000. After a decrease between 1980 and 1989, the asthma office visit rate increased by an average of 3.8% per year from 1989 to 1999. The asthma hospitalization rate grew by 1.4% per year from 1980 to 1999. Although childhood asthma deaths are rare, the asthma death rate increased by 3.4% per year from 1980 to 1998. Children aged 0 to 4 years had the largest increase in prevalence and had greater health care use, but adolescents had the highest mortality. The asthma burden was borne disproportionately by black children throughout the period. Racial disparities were largest for asthma hospitalizations and mortality: compared with white children, in 1998-1999, black children were >3 times as likely to be hospitalized and in 1997-1998 >4 times as likely to die from asthma. Recent data suggest that the burden from childhood asthma may have recently plateaued after several years of increasing, although additional years of data collection are necessary to confirm a change in trend. Racial and ethnic disparities remain large for asthma health care utilization and mortality.

Health-related quality of life and future health care utilization for asthma

Although health-related quality of life (HRQL) has been increasingly used as an outcome in asthma, its utility for identifying patients at risk for adverse asthma outcomes has not been established. In a prospective cohort study, to evaluate the longitudinal impact of HRQL on future health care utilization and cost among adults with asthma, accounting for known risk factors for utilization. A stratified random sample of 3,482 adult Northern CA Kaiser Permanente members with asthma was selected using computerized utilization databases and a screening survey item. Subjects completed a mail survey that included measures of generic (SF-12) and asthma-specific HRQL (ITG-Asthma Short Form battery). During the 12 months after survey completion, computerized utilization and cost data were ascertained. Better baseline asthma-specific HRQL was associated with a decreased risk of asthma-related emergency department visit or hospitalization during longitudinal followup (odds ratio per 10-point score increment 0.84; 95% confidence interval [CI] 0.74 to 0.95), controlling for demographic and clinical factors. Better baseline generic physical HRQL was associated with a decreased risk of future all-cause hospitalization (odds ratio 0.68; 95% CI 0.60 to 0.77). More favorable asthma-specific HRQL scores were also related to decreased asthma-related health care costs during the ensuing year (-0.086 log-dollars per 10-point score increment; 95% CI -0.11 to -0.06). Better generic physical HRQL scores were associated with lower total costs (-0.24 log-dollars; 95% CI -0.32 to -0.17). In a large cohort of adult health maintenance organization members with asthma, asthma-specific HRQL was associated with future asthma-related utilization and cost.

A Controlled Trial of an Environmental Tobacco Smoke Reduction Intervention in Low-Income Children With Asthma

To determine the effectiveness of a cotinine-feedback, behaviorally based education intervention in reducing environmental tobacco smoke (ETS) exposure and health-care utilization of children with asthma. Randomized controlled trial of educational intervention vs usual care. The pediatric pulmonary service of a regional pediatric hospital. ETS-exposed, Medicaid/Medi-Cal-eligible, predominantly minority children who were 3 to 12 years old and who were seen for asthma in the hospital's emergency, inpatient, and outpatient services departments (n = 87). Three nurse-led sessions employing behavior-changing strategies and basic asthma education and that incorporated repeated feedback on the child's urinary cotinine level. The primary measurements were the urinary cotinine/creatinine ratio (CCR) and the number of acute asthma medical visits. The secondary measurements were number of hospitalizations, smoking restrictions in home, amount smoked, reported exposures of children, and asthma control. The intervention was associated with a significantly lower odds ratio (OR) for more than one acute asthma medical visit in the follow-up year, after adjusting for baseline visits (total visits, 87; OR, 0.32; p = 0.03), and a comparably sized but nonsignificant OR for one or more hospitalization (OR, 0.34; p = 0.14). The follow-up CCR measurement and the determination of whether smoking was prohibited inside the home strongly favored the intervention group (n = 51) (mean difference in CCR adjusted for baseline, -0.38; p = 0.26; n = 51) (60; OR [for proportion of subjects prohibiting smoking], 0.24; p = 0.11; n = 60). This intervention significantly reduced asthma health-care utilization in ETS-exposed, low-income, minority children. Effects sizes for urine cotinine and proportion prohibiting smoking were moderate to large but not statistically significant, possibly the result of reduced precision due to the loss of patients to active follow-up. Improving ETS reduction interventions and understanding their mechanism of action on asthma outcomes requires further controlled trials that measure ETS exposure and behavioral and disease outcomes concurrently.

Self-reported food reactions and their associations with asthma.

The role of food reactions in asthma has not been well described. The objectives of this study were to evaluate the types of self-reported reactions to foods in asthmatic patients, and to determine the association between self-reported food reactions and self-reported severity of asthma and asthma health care utilization. We characterized 914 patients, aged 3-55 years, in a large health maintenance organization. We characterized the patients according to demographic data (age, sex, occupation, SES, marital status) and their asthma according to duration, triggers, severity (symptoms, FEV1 percentage predicted) and presence of atopy. Overall, 414 (45.3%) participants, primarily women, reported adverse reactions to food, particularly milk, red wine, eggs, chocolate, and peanuts. Those with food reactions were more likely to report having ever been hospitalized for breathing problems than those without food reactions (31% vs. 22%, two-tailed p = 0.004) although their asthma was not worse. Self-reported food reactions, particularly in females, may be associated with increased asthma health care utilization, and such patients may require closer health care management.