Effectiveness of Acute Asthma Care Among Inner-city Adults.
BACKGROUND
Acute asthma often requires expensive emergency department visits and hospitalizations, especially among economically disadvantaged inner-city adults. However, few studies have examined approaches for improving acute asthma care in this population.


METHODS
We conducted a cohort study involving patients who were discharged from a public hospital emergency department following acute asthma care between March 31, 1997, and August 5, 1999, to identify processes of care effective for improving peak expiratory flow rate at a 2- to 3-week follow-up. Adult patients who met the predetermined criteria for asthma, who underwent a baseline peak expiratory flow rate reading, and who did not have concurrent acute sinusitis or pneumonia were eligible (N = 448). Of the 365 patients enrolled in the study, 309 (84.7%) completed it. We used a multiple linear regression analysis adjusted for patient risk to assess the association between acute asthma care processes derived from the National Asthma Education Prevention Program guidelines (inhaled beta2-agonists, inhaled corticosteroids, systemic corticosteroids, asthma care follow-up, and patient asthma education) and percentage peak expiratory flow rate change at follow-up.


RESULTS
Systemic corticosteroids had a significant effect for increasing percentage peak expiratory flow rate change at the 2- to 3-week follow-up for all asthma exacerbation severity levels (beta = 26.1; 95% confidence interval, 1.8-50.5; P =.04) and severity levels specified by the National Asthma Education Prevention Program guidelines (beta = 31.6; 95% confidence interval, 8.1-55.1; P =.01).


CONCLUSIONS
Outpatient systemic corticosteroids were effective for improving lung function 2 to 3 weeks after acute asthma care, and their use should reduce asthma-related morbidity, especially among economically disadvantaged inner-city adults.
Coyle
Yvonne Marie
YM
Division of General Internal Medicine, The University of Texas Southwestern Medical Center at Dallas, 75390-9103, USA. yvonne.coyle@utsouthwestern.edu
Aragaki
Corinne Chie
CC
Hynan
Linda Susan
LS
Gruchalla
Rebecca Sue
RS
Khan
David Ali
DA
D000208:Acute Disease; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000318:Adrenergic beta-Agonists / Q000627:therapeutic use; D000328:Adult; D000359:Aftercare; D001249:Asthma / Q000503:physiopathology / Q000628:therapy*; D016009:Chi-Square Distribution; D005260:Female; D006779:Hospitals, Public; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic; D010366:Peak Expiratory Flow Rate; D011203:Poverty; D011446:Prospective Studies; D012129:Respiratory Function Tests; D014505:Urban Population
D000305:Adrenal Cortex Hormones; D000318:Adrenergic beta-Agonists