title: Inhaled corticosteroids and allergy specialty care reduce emergency hospital use for asthma.
abstract: BACKGROUND
  The interrelationships between optimal inhaled corticosteroid (IC) therapy, allergy specialist care, and reduced emergency hospital care for asthma have not been well defined.
  
  
  OBJECTIVE
  We sought to evaluate the independent effectiveness of various levels of IC dispensing and allergy specialist care in reducing subsequent emergency asthma hospital use.
  
  
  METHODS
  Asthmatic patients (n = 9608) aged 3 to 64 years were identified from an electronic database of a large health maintenance organization. The outcome was any year 2000 asthma hospitalization or emergency department visit. The main predictors were at least one allergy department visit and the number of IC canisters dispensed in 1999. Analyses were adjusted for age, sex, insurance type, and asthma severity (1999 emergency asthma hospital use, beta-agonist use, and oral corticosteroid use).
  
  
  RESULTS
  Dispensing of 7 or more canisters of ICs (odds ratio [OR], 0.64; 95% CI, 0.43-0.94) and allergy care (OR, 0.73; 95% CI, 0.55-0.97) were associated with reduced subsequent emergency asthma hospital use. More patients with allergy specialist care than those without such care received 7 or more dispensations of ICs (24.7% vs 8.3%, P <.001). When 7 or more dispensations of ICs and allergy specialist care were simultaneously included in an adjusted model, both ICs (OR, 0.68; 95% CI, 0.46-1.00) and allergy care (OR, 0.77; 95% CI, 0.58-1.02) were independently associated with a lower risk of year 2000 emergency asthma hospital care, although significance was borderline.
  
  
  CONCLUSIONS
  Allergy care reduces emergency hospital use for asthma by increasing use of ICs but probably also has an independent effect.
authors.affiliation: Department of Allergy, Kaiser-Permanente Medical Center, San Diego, Calif 92111, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Schatz
authors.forename: E Francis
authors.initials: EF
authors.lastname: Cook
authors.forename: Randy
authors.initials: R
authors.lastname: Nakahiro
authors.forename: Diana
authors.initials: D
authors.lastname: Petitti
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003695:Delivery of Health Care; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007158:Immunologic Techniques; D008297:Male; D008875:Middle Aged
chemical_list: D000305:Adrenal Cortex Hormones