title: Inhaled anti-inflammatory pharmacotherapy and subsequent hospitalizations and emergency department visits among patients with asthma in the Texas Medicaid program.
abstract: BACKGROUND
  Rates of asthma-related hospitalizations and emergency department (ED) visits continue to rise in the United States. The National Asthma Education and Prevention Program recommends the use of controller pharmacotherapy for patients with persistent asthma.
  
  
  OBJECTIVE
  To investigate the influence of initiating inhaled anti-inflammatory (IAI) pharmacotherapy following an asthma-related hospitalization or ED visit on risk of subsequent morbid events.
  
  
  METHODS
  Texas Medicaid asthma-related medication and medical services claims for September 1997 to July 2001 were extracted. An asthma-related morbid event served as the index event (ED visit or hospitalization for cohort 1; hospitalization for cohort 2). Members of both cohorts were then followed up until a subsequent morbid event occurred or until 1 year after index. Logistic regression was used to compare patients who used IAI medication within 100 days following their index event with nonusers.
  
  
  RESULTS
  Controlling for demographic and resource use variables, there was a 52% reduction in the risk of a subsequent ED visit or hospitalization in the year following the index event among users of IAI medication within cohort 1 (risk ratio [RR], 0.485; 95% confidence interval [CI], 0.416-0.565; P < .001). There was a 61% reduction in the risk of a subsequent hospitalization among users of IAI medication within cohort 2 (RR, 0.393; 95% CI, 0.284-0.545; P < .001).
  
  
  CONCLUSIONS
  Less than half of the patients had a prescription claim for an IAI medication within 100 days following their index event. Patients who received these medications had a lower risk of a subsequent asthma-related morbid event for the next year.
authors.affiliation: West Virginia University, School of Pharmacy, Morgantown, West Virginia 26506-9510, USA. msmith2@hsc.wvu.edu
authors.forename: Michael James
authors.initials: MJ
authors.lastname: Smith
authors.forename: Karen L
authors.initials: KL
authors.lastname: Rascati
authors.forename: Bennie Coleman
authors.initials: BC
authors.lastname: McWilliams
mesh_terms: D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D018927:Anti-Asthmatic Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D001249:Asthma / Q000188:drug therapy*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004636:Emergency Service, Hospital; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D012720:Severity of Illness Index; D013781:Texas; D016896:Treatment Outcome
chemical_list: D018927:Anti-Asthmatic Agents; D000893:Anti-Inflammatory Agents