Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma

Schatz, Michael; Cook, E. Francis; Nakahiro, Randy; Petitti, Diana B.

doi:10.1067/mai.2003.178

Cited by 66 publications

(48 citation statements)

References 27 publications

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“…Our findings suggest that higher doses of inhaled steroids may lead to a decrease in ED visits and hospital admissions. This is consistent with the findings of Schatz et al 9 These investigators found a trend toward decreased ED visits and admissions with increased use of inhaled canisters. This differs from the findings of Sin and Man who reported that low-dose therapy appears to be as effective as high-dose inhaled steroid therapy.…”

Section: Ss Discussionsupporting

confidence: 92%

“…Use of ICS has been associated with reduced ED visits and admissions. [9][10][11] In patients with moderate or severe persistent asthma, the addition of an inhaled long-acting beta-agonist (LABA) to an ICS leads to improvement of pulmonary function, reduces exacerbations requiring the use of oral steroids, and reduces the use of short-acting beta-agonists (SABAs). 12 Improved refill persistence has been reported when the combination of fluticasone and salmeterol is administered in a fixed combination (Advair, henceforth referred to as FSA) compared with use of separate inhalers.…”

mentioning

confidence: 99%

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Effects on Resource Utilization of Adding Salmeterol in Combination or Separately to Inhaled Corticosteroids

Chan

Hui²,

Spence³

2007

JMCP

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BACKGROUND: The addition of a long-acting beta-agonist (LABA) to an inhaled corticosteroid (ICS) for patients with moderate or severe persistent asthma improves outcomes such as pulmonary function, reduces exacerbations requiring oral steroids, and reduces use of rescue beta-agonists.OBJECTIVE: To assess the key resource utilization outcomes of adding salmeterol, a LABA, to fluticasone, an ICS, either as a fixed-combination inhaler (fluticasone-salmeterol [FSA] or as a separate inhaler used concomitantly with the ICS beclomethasone (BSA).METHODS: This is a retrospective, observational database study that extracted data from electronic medical and prescription records in which the prescription written was identical to the prescription dispensed. The sample included asthmatic patients aged 12 to 55 years who received a medium dose of an ICS (240-480 mcg of beclomethasone, 264-660 mcg of fluticasone, 600-1,200 mcg of budesonide, or 1,000-2,000 mcg of triamcinolone acetonide) between July 2001 and December 2002 and had salmeterol added to the regimen (index date). From this population of patients, the analytical cohort was derived to include 1,213 patients who received FSA and a matched cohort of 1,213 patients who received BSA. The primary endpoint was an asthmarelated event (ARE), which was defined as (1) an emergency department (ED) visit or (2) hospital admission with a primary asthma diagnosis code (International Classification of Diseases, Ninth Revision, Clinical Modification [ICD-9-CM] code 493.xx). The secondary endpoints were the (1) use of short-acting beta-agonist (SABA) equivalents, (2) percentage of patients who received 1 or more oral steroid prescriptions, (3) patterns of ICS use, and (4) refill rates of salmeterol. All data were collected for 6 months before and 6 months after the index date, defined as the first prescription dispensed to the patient that included salmeterol as an ingredient.RESULTS: Outcomes were improved in both cohorts with no significant difference in the likelihood of an ARE, 60 patients (4.9%) for FSA and 90 patients (8.1%) for BSA (odds ratio [OR], 0.668; 95% confidence interval [CI], 0.443-1.008); P = 0.055). FSA was associated with a reduction in AREs of 55% (10.9%-4.9%; P <0.001), and BSA with a reduction in AREs of 39% (13.3%-8.1%; P <0.001). FSA compared with BSA was associated with a greater reduction in SABA use (-0.66 canister equivalents over 6 months, P <0.001) and a lower likelihood of filling an oral steroid prescription, 35.8% of FSA patients compared with 38.0% of BSA patients (OR, 0.801; 95% CI, 0.662-0.970; P = 0.023). For the 132 FSA patients (10.9%) and 162 BSA patients (13.4%) who had an ARE in the preperiod, those who received FSA in the postperiod had a 47% lower likelihood of a subsequent ARE, 17.4% of 132 patients compared with 27.8% of 162 BSA patients (OR, 0.527; 95% CI, 0.291-0.954; P = 0.034). No ARE differences in subgroup analyses were noted for patients without an ARE in the preperiod or for patients using more than 6 canisters of SABA. More pat...

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Section: Ss Discussionsupporting

confidence: 92%

mentioning

confidence: 99%

Effects on Resource Utilization of Adding Salmeterol in Combination or Separately to Inhaled Corticosteroids

Chan

Hui²,

Spence³

2007

JMCP

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“…1,8,21 Obat yang paling efektif sekalipun tidak memiliki nilai jika tidak digunakan secara tepat. Kepatuhan yang rendah terhadap pengobatan asma terutama obat pengontrol dikaitkan dengan peningkatan kunjungan ke gawat darurat dan rawat inap serta kematian akibat asma.…”

unclassified

Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Ferliani¹,

Sundaru²,

Koesnoe³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai sebagian besar pasien meskipun telah tersedia pedoman manajemen asma internasional dan terapi yang terbukti efektif. Tingkat kontrol asma yang rendah diantaranya disebabkan kepatuhan terhadap pengobatan yang rendah. Hingga saat ini faktor-faktor yang berhubungan dengan kepatuhan berobat pasien asma tidak terkontrol masih sedikit diteliti. Penelitian ini bertujuan mengetahui profil kepatuhan berobat pada pasien asma tidak terkontrol dan hubungan antara faktor terkait pasien, faktor terkait penyakit, faktor terkait pengobatan, faktor terkait sosial ekonomi dan faktor terkait sistem pelayanan kesehatan terhadap kepatuhan berobat pasien asma tidak terkontrol Metode. Penelitian potong lintang terhadap pasien asma tidak terkontrol yang datang ke poliklinik alergi dan imunologi RSCM dari bulan Februari 2012 hingga Mei 2012. Semua pasien asma yang memenuhi kriteria dilakukan anamnesis, pemeriksaan fisis lengkap, pengisian kuesioner, tes kontrol asma, tes Beck Depression Inventory dan Asthma General Knowledge Questionnaire. Analisis awal hubungan kepatuhan dengan faktor-faktor yang diteliti menggunakan uji Chisquare. Kemudian dilanjutkan dengan regresi logistik untuk setiap variabel yang bermakna.Hasil. Dari 125 pasien asma tidak terkontrol didapatkan kepatuhan rendah sebesar 56 %. Dilakukan analisis bivariat terhadap faktor-faktor yang berhubungan dengan kepatuhan yaitu usia, pendidikan, pengetahuan asma, penghasilan, depresi, sediaan obat yang digunakan, keyakinan pasien terhadap dokter, asuransi kesehatan dan hubungan keluarga dan didapatkan pengetahuan bermakna dengan p=0,001 (IK 1,789). Kemudian dilakukan regresi logistik didapatkan pengetahuan paling berpengaruh terhadap kepatuhan (p=0,003) dengan OR 6,933 (IK 1,789) Simpulan. Kepatuhan berobat pada pasien asma tidak terkontrol masih rendah dengan pengetahuan merupakan faktor yang berhubungan dengan kepatuhan. Kata kunci. asma, kepatuhan PENDAHULUANAsma merupakan penyakit peradangan kronis pada saluran napas yang diderita lebih dari 300 juta orang didunia.1,2 Secara umum, prevalensi asma cenderung meningkat dari tahun ke tahun baik di negara maju maupun berkembang.2-4 Berdasarkan data di Amerika pada tahun 2009, 1 dari 12 orang (sekitar 25 juta,atau 8% dari populasi) menderita asma. Angka ini merupakan peningkatan dari prevalensi tahun 2001 yaitu 1 dari 14 (sekitar 20 juta, atau 7%). 4Di Indonesia secara nasional prevalensi asma juga meningkat dari 4,2 % tahun 1995 menjadi 5,4 % tahun 2001. Kota Jakarta sendiri memiliki prevalensi gejala asma yang cukup besar yaitu 7,5 % pada tahun 2005. Masalahnya bukan sekedar kenaikan prevalensi semata, tetapi yang tidak kalah penting adalah dampak dari asma itu sendiri. 5Tujuan pengobatan asma adalah untuk mencapai dan mempertahankan kontrol klinis.2-6 Mencapai kontrol asma masih merupakan tujuan yang sulit dicapai oleh sebagian besar pasien. Kenyataan ini terus terjadi meskipun telah tersedianya pedoman manajemen asma internasional selama le...

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“…Similar methods have been employed previously to define a cohort of asthma patients, as the prescription of multiple asthma items implies a diagnosis of asthma. 21 We grouped patients into one of four mutually exclusive treatment groups indicating a diagnosis of asthma. The first three groups represent treatment steps adapted from the British Guideline on the Management of Asthma 10 and are consistent with recommendations for the treatment of childhood asthma in New Zealand (Table 1).…”

Section: Definition Of Asthma Patientsmentioning

confidence: 99%

“…In the USA, studies have used claims data to identify patients with asthma from medicines dispensed, and hospital admissions indicating a primary diagnosis of asthma to evaluate the effectiveness of treatment guidelines in reducing hospital admissions in patients with asthma. 12,21,22 In this study we aimed to determine whether the poor asthma outcomes that have been previously documented in Mãori and Pacific children compared with children of other ethnicities are also associated with less optimal asthma treatment and lower adherence to guidelines. To achieve this we conducted an analysis of New Zealand's national health databases to establish whether there are ethnic disparities in the way all children in New Zealand are treated for asthma.…”

mentioning

confidence: 99%

Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases

Gillies¹,

Tomlin²,

Dovey

et al. 2013

Primary Care Respiratory Journal

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Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma

Cited by 66 publications

References 27 publications

Effects on Resource Utilization of Adding Salmeterol in Combination or Separately to Inhaled Corticosteroids

Effects on Resource Utilization of Adding Salmeterol in Combination or Separately to Inhaled Corticosteroids

Kepatuhan Berobat pada Pasien Asma Tidak Terkontrol dan Faktor-Faktor yang Berhubungan

Ethnic disparities in asthma treatment and outcomes in children aged under 15 years in New Zealand: analysis of national databases

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