title: Intranasal steroids and the risk of emergency department visits for asthma.
abstract: BACKGROUND
  In patients with asthma, treatment for associated conditions, such as rhinitis, is recommended. It is unknown whether this treatment can reduce the risk for emergency department (ED) visits for asthma.
  
  
  OBJECTIVE
  We sought to determine whether treatment with intranasal steroids or prescription antihistamines in persons with asthma is associated with a reduced risk for ED visits caused by asthma.
  
  
  METHODS
  We performed a retrospective cohort study of members of a managed care organization aged greater than 5 years who were identified during the period of October 1991 to September 1994 as having a diagnosis of asthma by using a computerized medical record system. The main outcome measure was an ED visit for asthma.
  
  
  RESULTS
  Of the 13,844 eligible persons, 1031 (7.4%) had an ED visit for asthma. The overall relative risk (RR) for an ED visit among those who received intranasal corticosteroids, adjusted for age, sex, frequency of orally inhaled corticosteroid and beta-agonist dispensing, amount and type of ambulatory care for asthma, and diagnosis of an upper airways condition (rhinitis, sinusitis, or otitis media), was 0.7 (95% confidence interval [CI], 0.59-0.94). For those receiving prescription antihistamines, the risk was indeterminate (RR, 0.9; 95% CI, 0.78-1.11). When different rates of dispensing for intranasal steroids were examined, a reduced risk was seen in ED visits in those with greater than 0 to 1 (RR, 0.7; 95% CI, 0.57-0.99) and greater than 3 (RR, 0.5; 95% CI, 0.23-1.05) dispensed prescriptions per year.
  
  
  CONCLUSIONS
  Treatment of nasal conditions, particularly with intranasal steroids, confers significant protection against exacerbations of asthma leading to ED visits for asthma. These results support the use of intranasal steroids by individuals with asthma and upper airways conditions.
authors.affiliation: Department of Medicine, University of Adelaide, The Queen Elizabeth Hospital Campus, Woodville, Australia.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Adams
authors.forename: Anne L
authors.initials: AL
authors.lastname: Fuhlbrigge
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Finkelstein
authors.forename: Scott T
authors.initials: ST
authors.lastname: Weiss
mesh_terms: D000281:Administration, Intranasal; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006634:Histamine H1 Antagonists / Q000627:therapeutic use; D006801:Humans; D008297:Male; D012189:Retrospective Studies
chemical_list: D000305:Adrenal Cortex Hormones; D006634:Histamine H1 Antagonists