Asthma control index predicts later healthcare use

NEW YORK (Reuters Health) – A simple measure of short-term asthma control is effective in predicting asthma-related healthcare use over the following year, according to a study involving close to 5000 members of an HMO.

Dr. William M. Vollmer, of Kaiser Permanente Center for Health Research, Portland, Oregon, and colleagues note that such instruments should be useful not only for individual physicians, but also as an adjunct to population-based asthma management.

The researchers evaluated the utility of the Asthma Therapy Assessment Questionnaire, which was completed by 4795 HMO members. The self-administered instrument scores current levels of asthma control on a scale of 0 to 4.

The researchers then compared scores with asthma-related healthcare use, including routine care, hospitalizations, emergency department visits, and prescriptions for various types of asthma medication over the subsequent 12 months. The findings were published in the January 15th issue of the American Journal of Respiratory and Critical Care Medicine.

More than 50% of patients had at least one control problem, and 13.5% had three or four. Both acute and routine healthcare use increased with increasing numbers of control problems.

Those with three or four problems were 3.5 times more likely than those with no problems to have an acute care episode. There were also significant increases in the relative risk of an acute care episode among subjects with two control problems (1.7) or one control problem (1.4).

These findings, Dr. Vollmer told Reuters Health, "support the value of this simple, easy to administer index as an asthma 'vital sign' that can help to help identify patients who are at risk for future acute exacerbations."

Patients reporting three or four control problems, he added, "should benefit from a review of pharmacologic therapy and adherence, and potentially from increased educational efforts including triggers and allergen avoidance."

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