Effectiveness of Acute Asthma Care Among Inner-city Adults
2003; American Medical Association; Volume: 163; Issue: 13 Linguagem: Inglês
10.1001/archinte.163.13.1591
ISSN1538-3679
AutoresYvonne M. Coyle, Corinne Aragaki, Linda S. Hynan, Rebecca S. Gruchalla, David A. Khan,
Tópico(s)Inhalation and Respiratory Drug Delivery
ResumoBackground 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 β 2 -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 (β = 26.1; 95% confidence interval, 1.8-50.5; P = .04) and severity levels specified by the National Asthma Education Prevention Program guidelines (β = 31.6; 95% confidence interval, 8.1-55.1; P = .01). Conclusion 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.
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