Treatment patterns in the months prior to and after asthma-related emergency department visit

Background: There are 2 million asthma-related emergency department (ED) events each year in the United States. The underrecognition and undertreatment of asthma is believed to be associated with this high level of morbidity. This study was designed to describe the treatment patterns in the year prior to the ED event and for 2 months after the event. Methods: This retrospective observational study utilized an integrated managed care database that contained administrative claims from > 20 managed care plans across the United States. All patients with at least one ED visit for asthma during 2001 were included. Patients were required to have data available 12 months prior to and 2 months following the ED visit of interest, and were excluded if they had made an asthma-related ED visit within 12 months of the identified event. Results: There were 12,636 patients identified with an asthma-related ED visit. In the year prior to the ED event, 25.1% of the patients received an inhaled corticosteroid (ICS), 29.9% received an oral corticosteroid (OCS), and 53.5% received a short-acting beta-agonist (SABA). Overall, there were three albuterol units dispensed for every ICS unit dispensed in the 12-month period prior to the ED event. Ninety-four percent of patients had made an office visit in the prior year, but only 13.3% underwent spirometry testing. Prescriptions dispensed for ICSs and OCSs increased 2.6-fold and 7.5-fold, respectively, in the month after the ED event, and dispensing rates reverted approximately to baseline rates by the second month after the index ED event. Conclusion: This study demonstrates the dependence of this population on the use of rescue medications, including SABA and OCS, to treat their asthma. Furthermore, the ED event resulted in only an incremental short-term improvement in ICS-containing controller treatment.