National Asthma Education Program Expert Research Articles

Cross-sectional analysis of the relationship between national guideline recommended asthma drug therapy and emergency/hospital use within a managed care population.

Nationally recognized clinical guidelines provide recommended therapies for the treatment of asthma. Research demonstrating the impact of guideline recommended drug therapy on utilization [emergency department (ED) and hospitalizations] is beneficial when considering these guidelines for managing asthmatics within a managed care setting. The purpose is to determine the relationship between ED/hospital claims and selected asthma drug therapies as recommended by the National Asthma Education Program Expert Panel and the National Heart, Lung, and Blood Institute/ World Health Organization Workshop. The analysis is a retrospective, cross-sectional study within a managed care organization (MCO), serving 359,464 patients in the state of Florida. Asthma patients from all lines of business (Medicaid, Medicare, commercial) were stratified into subgroups based on the type of drug therapy utilized. Members included were those identified as having at least one prescription filled for an asthma medication between January 1, 1995 and June 30, 1995 and at least six consecutive months of enrollment within the health plan. Pharmacy and medical claims data were collected over a 1.5-year study period (January 1, 1995 through June 30, 1996) to assure follow-up on utilization was at a minimum 6 months and maximum 1.5 years. Outcomes were measured based on patient utilization of tertiary medical services (asthma-related ED and hospital visits) through claims. Total membership within the Florida MCO, reflected 359,464 members of whom 5.2% were identified as asthmatic. The asthma members were reviewed based on pharmacy claims data, identifying 26.2% of the members utilizing inhaled corticosteroids concomitantly with a short-acting beta2-agonist. Upon further review of this subset, 85% were utilizing short-acting beta2-agonists in quantities at or below recommended dosages. Patients not utilizing the beta2-agonist therapy according to the recommended dosing guidelines had a significantly higher incidence (P = .001) of ED and hospital use. The remaining asthma population was reviewed, identifying 33.2% of the members utilizing short-acting beta2-agonists alone. This subset revealed 97.6% were utilizing therapy according to the beta2-agonist dosing guidelines. Patients not utilizing the beta2-agonist therapy according to dosing guidelines had a significantly higher incidence (P = .016) of ED and hospital use. Assessment of asthma therapy in a managed care population demonstrates that there is a lower proportionate use of the ED and hospital in those patients treated in accordance to the asthma guideline recommendations.

FDA Varicella Warning

To the Editor.— In a recent Food and Drug Administration (FDA) medical bulletin, letin,1 the FDA issued a warning that severe varicella infection may follow in individuals for whom corticosteroid therapy has been prescribed. Included in their warning was the use of all formulations of corticosteroids, without reference to dosage or demonstration of immunosuppression. In view of the fact that there are thousands of children receiving inhaled corticosteroids for the treatment of their asthma, and that this form of therapy recently has been not only condoned but recommended by the National Asthma Education Program Expert Panel Report,2 we feel that more research and education are required prior to issuing such a warning.

National Asthma Education Program Expert Panel Report

1. Asthma, a chronic lung disease that affects 10 million Americans, is receiving increased attention as a public health problem due to increased occurrence and number of reported deaths. 2. This article presents an overview of the National Asthma Education Program Expert Panel guidelines, specifically addressing the definition and pathophysiology of asthma, effective management and control of asthma, and special considerations in asthma management. 3. Implications of the Expert Panel guidelines for occupational health nurses are addressed.

Adjunctive aminophylline for acute asthma may reduce unscheduled hospitalization

TherapeuticsNovember 1, 1991Adjunctive aminophylline for acute asthma may reduce unscheduled hospitalizationJames Li, MDJames Li, MDMayo Clinic, Rochester, Minnesota, USA (J.L.)Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/ACPJC-1991-115-3-083 SectionsAboutFull Text ToolsAdd to favoritesDownload CitationsTrack Citations ShareFacebookTwitterLinkedInRedditEmail Source CitationWrenn K, Slovis CM, Murphy F, Greenberg RS. Aminophylline therapy for acute bronchospastic disease in the emergency room. Ann Intern Med. 1991 Aug 15;115:241-7.Reference1 National Heart, Lung, and Blood Institute. National Asthma Education Program Expert Panel Report. Executive Summary: Guidelines for the Diagnosis and Management of Asthma. Bethesda, Maryland: National Institutes of Health; 1991. Google Scholar Author, Article, and Disclosure InformationAffiliations: Mayo Clinic, Rochester, Minnesota, USA (J.L.) PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails November 1, 1991Volume 115, Issue 3Page: 83KeywordsAsthmaBloodBody weightBronchodilatorsChronic obstructive pulmonary diseaseDrugsEdemaHeartHospitalizationsInsulinIschemiaLungsPulmonary functionSodiumSulfates ePublished: 9 March 2020 Issue Published: November 1, 1991 Copyright & PermissionsCopyright © 1991 by American College of Physicians. All Rights Reserved.Loading ...