Timing of Emergency Department Visits for Childhood Asthma after Initial Inhaled Corticosteroid Use

Abstract

Inhaled corticosteroids can prevent acute exacerbations and emergency visits when used as part of a chronic care plan for long-term control of asthma, but low patient adherence and inadequate provider prescribing (clinical inertia) can limit these benefits. State Medicaid programs are a major source of insurance coverage for low-income children, paying for medications and preventive care, as well as bearing the cost of adverse outcomes for common chronic conditions in childhood, such as asthma. This study measured the incidence and timing of emergency department (ED) visits in the first 90 days after an initial inhaled corticosteroid prescription (ICS-Rx) among 43,156 Medicaid-enrolled children with a diagnosis of asthma in 14 southern states in 2007. One in 5 children (19.6%) with asthma had at least 1 ED visit in the first 90 days after initial ICS-Rx; 10% of these visits occurred within the first 48 hours, and 25% occurred within the first week. Continued ICS-Rx use was associated with lower risk of an ED visit. There were no racial differences in the ED visit rates. Initial ICSRx for Medicaid-enrolled children is a warning flag for short-term risk of asthma-related ED visits, whereas continued ICS-Rx use is protective for at least 90 days. Primary care follow-up may be needed within the first 2 days after initial ICS-Rx to prevent adverse outcomes. Medicaid programs could use claims data for surveillance of adherence to guideline-concordant therapy and for sentinel events marking windows of a higher risk for ED visits.

Quality of Life in Children with Asthma versus Healthy Children

“…Childhood asthma is among the commonest causes of emergency admission, hospitalisation and absenteeism from school [ 8 ]. The high prevalence of hospitalisation and death from asthma has to do with poverty, ethnic minority and urban living [ 9 ].…”

Defining asthma and assessing asthma outcomes using electronic health record data: a systematic scoping review

“…Assessing asthma severity 18 studies used 20 different algorithms to assess asthma severity (supplementary table E10) as binary (i.e. severe versus nonsevere asthma) [15,23,[25][26][27][28][29][30][31][32][33][34][35][36][37][38] or ordinal variables (mild, moderate and severe asthma [39]; low-, moderate-and high-risk asthma [40]). The algorithms were based on one or more of the following asthma-related variables: number and/or dosage of prescriptions (i.e.…”

“…Almost all algorithms (n=17) used prescriptions (either alone or with other variables), while one algorithm was based only on hospitalisations and emergency department visits [36]. The intervals over which asthma severity was assessed were 3 [29], 6 [38], 12 [15, 23, 28, 30-32, 34, 36, 37, 39, 40] or 24 months [33,35], or unclear [26,27].…”

Creating and utilising the Wales Asthma Observatory to support health policy, health service planning and clinical research

“…1.10), as binary (i.e. severe vs. non-severe asthma) [160,168,[170][171][172][173][174][175][176][177][178][179][180][181][182][183] or ordinal variables (mild, moderate, and severe asthma [184]; or low, moderate, and high-risk asthma [185]). The algorithms were based on one or more of the following asthmarelated variables: number and/or dosage of prescriptions-namely short acting beta agonist (SABA), inhaled corticosteroid (ICS), OCS, and leukotriene receptor antagonist (LTRA)-and number of hospitalisations, ED and outpatient visits.…”

“…Almost all algorithms (17) used prescriptions (either alone or with other variables), while one algorithm was based only on hospitalisations and ED visits [181]. The intervals over which asthma severity was assessed were three [174], six [183], 12 [160, 168, 173, 175-177, 179, 181, 182, 184, 185], 24 months [178,180], or unclear [171,172].…”