Use of inhaled corticosteroids following discharge from an emergency department for an acute exacerbation of asthma

Abstract

Background: Most patients who have an asthma exacerbation leading to a visit to an emergency department (ED) will benefit from treatment with inhaled corticosteroids (ICS) at discharge. We investigated whether asthmatic children and adolescents were receiving ICS after discharge from the ED and identified the characteristics of patients and physicians associated with their use. Methods: A cohort of 4042 asthmatic patients aged 5-17 years was selected from the administrative database of the Régie de l'assurance maladie du Québec between 1997 and 1999. The proportion of patients using ICS 1, 3, and 6 months after ED discharge was estimated. Using GEE models the independent contribution of sociodemographic variables, markers of asthma severity, prior use of healthcare services and ICS, and physician characteristics was investigated on the likelihood of using ICS after ED discharge. Results: 68% of children and 51% of adolescents had a valid prescription for ICS in the month following discharge. At 6 months after discharge the corresponding figures were 77% and 60%. The strongest predictors of ICS use were age, with adolescents being less likely to use ICS than children (OR 0.49; 95% CI 0.43 to 0.56), prior use of ICS (OR 2.28; 95% CI 2.00 to 2.61), and filling a prescription for oral corticosteroids in the month following discharge (OR 2.29; 95% CI 2.03 to 2.58). However, patients who had an ED visit or a hospital admission for asthma during the 6 months before discharge were not more likely to use ICS after discharge. Conclusion: A large proportion of patients with clear markers of uncontrolled or severe asthma did not have a valid prescription for an ICS after discharge from the ED.

Asthma exacerbations during the first trimester of pregnancy and the risk of congenital malformations among asthmatic women

“…The RAMQ and MED-ECHO databases have often been used in the past for epidemiologic research in the field of asthma. [19][20][21][22][23] Data recorded in the RAMQ Medication Prescriptions database and the medical diagnosis for asthma recorded in the RAMQ Medical Services database have been formally evaluated and found to be valid. 24,25 Moreover, some medical diagnoses recorded in the MED-ECHO database have been found to be valid.…”

“…The mother's sociodemographic characteristics included age at conception (18,(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34), and 35 years), receipt of social assistance during pregnancy or 2 years prior (yes/no), area of residence at delivery (rural/urban), and level of education (12, 13 years, and missing). Maternal chronic conditions included diabetes mellitus (yes/no), epilepsy (yes/no), and use of recognized teratogenic medications during the first trimester of pregnancy (yes/no).…”

Persistence, adherence, and effectiveness of combination therapy among adult patients with asthma

“…The RAMQ Medical Services file includes claims data on medical services such as site of medical practice (outpatient clinic, emergency department [ED], hospitalization); nature of the medical act, date, and diagnostic information (International Classification of Disease, 9th revision [ICD-9] codes); and the encrypted identification and physician's specialty. 26 The RAMQ Prescription Drugs file, which has been validated for research and previously used for pharmacoepidemiologic research studies, 27,28 contains data on prescriptions filled at community pharmacies: drug name, date, dose, quantity, and duration as indicated by the pharmacist, as well as the encrypted identification and prescribing physician's specialty. The MED-ECHO database contains data on acute care hospitalizations, such as date of admission, length of stay, and primary and secondary diagnoses.…”

One-year outcomes of inhaled controller therapies added to systemic corticosteroids after asthma-related hospital discharge

“…Factors such as personal experience of a severe asthma attack and changes in asthma management after an admission can cause patients in the post-discharge period to have different adherence, and respond differently, to controller therapies. Blais et al investigated the long-term adherence to inhaler controllers in children and adolescents after an asthma exacerbation [32]. They reported that a prescription for SCS was a significant predictor of long-term use of ICS.…”