Association of Asthma Control with Health Care Utilization

Abstract

Population-based disease management should be enhanced by good risk assessment models and instruments. We prospectively evaluated the ability of a simple measure of short-term asthma control (scored 0 to 4) to predict asthma 12-mo health care utilization (HCU). A total of 5,172 adult asthma patients completed a brief questionnaire in fall 1997 to assess current level of asthma control. We then evaluated HCU for calendar year 1998. Ninety-three percent had health plan eligibility in 1998 and were included in this analysis. Both acute and routine asthma utilization increased with increasing numbers of asthma control problems. Rates of acute care episodes were 3.5 (95% confidence interval [CI] = 2.9, 4.3) times more likely for those with 3 to 4 control problems versus those with no control problems. Lesser, but statistically significant, increases were seen for those with two (relative risk [RR] = 1.7, 95% CI = 1.4, 2.2) or one (RR = 1.4, 95% CI = 1.1, 1.8) control problems. These patterns were similar for men and women, and diminished with increasing age. The asthma control index contributed significantly to prospective prediction models even after adjusting for administrative data such as medication use and prior HCU. These data reinforce the usefulness of measures of short-term asthma control both for the individual clinician and for those interested in population-based asthma management.

Asthma Control Assessment Tools

“…Respondents are graded as either having or not having a control problem in each one of these 4 items; the item scores are then summed to provide a total, which ranges from 0 (no asthma control problems) to 4 (4 asthma control problems). 8,40,66,67 Skinner et al 71 developed a parent completed ATAQ version to identify children and adolescents (5-17 y old) with current problems in asthma control. This version was derived from the adult version developed by Vollmer et al 66 …”

“…40 Vollmer et al 66 reported that only 2% of those with an ATAQ score of 0 had been hospitalized for asthma in the past year, versus 24% of those with an ATAQ score of 4. In a 12-month prospective study, 67 subjects with ATAQ scores of 3 or 4 (ie, 3 or 4 control problems) were 5 times more likely to be hospitalized, 5.4 times more likely to be seen in an emergency department, and twice as likely to have routine asthma care visits compared with subjects with no control problems.…”

Addressing Asthma from a Public Health Perspective

“…Risk assessment models have used empirical data to successfully predict, in the short term, who is most at risk for various outcomes and thus most likely to have an impact on those outcomes in the future (Eisner et al, 2002;Li et al, 1995;Magid et al, 2004;Vollmer et al, 2002). These models include many variables, such as demographic data, various indicators of current asthma control, prescription patterns, and healthcare utilization history.…”

Airway Remodeling and Lack of Bronchodilator Response in Steroid Resistant (SR) Asthma

“…1,8 Given the recent increase in asthma prevalence and severity worldwide, steroid resistance has become a challenging health problem that contributes to the high costs of asthma care. 8,9 Persistent asthma has been reported to contribute to airway remodeling which can result in permanent biomechanical and pathologic alteration of asthmatic airways. 10-12 Structural changes seen in asthmatic patients can include thickening of the airway wall reticular basement membrane, formation of abnormal elastic fiber network, alterations in airway cartilage structure, angiogenesis, increase in airway smooth muscle mass.…”