ABSTRACT
Asthma care management programs may improve outcomes, but it is not clear which aspects of such management are responsible for the improvement. We performed a randomized controlled trial of a limited intervention (one visit with asthma self-management education and provision of inhaled budesonide) compared to this visit plus regular asthma care manager follow-up. Quality of life, symptom-free days, emergency hospital care, and beta-agonist dispensings did not differ between groups at 12 months. Patients who entered the study did receive significantly less beta-agonists in the follow-up year than patients who did not enter the study. These data suggest that the limited intervention in our setting improved outcomes but that regular care manager follow-up thereafter did not add significantly to this intervention.
Subject(s)
Asthma/therapy , Patient Care Management/methods , Administration, Inhalation , Adolescent , Adult , Bronchodilator Agents/administration & dosage , Budesonide/administration & dosage , Drug Utilization , Female , Glucocorticoids/administration & dosage , Humans , Male , Middle Aged , Patient-Centered Care , Quality of Life , Risk , Socioeconomic FactorsABSTRACT
BACKGROUND: Asthma is a chronic inflammatory lung disease. It is commonly diagnosed and treated on the basis of clinical impression, although national guidelines recommend documenting reversible airflow obstruction. OBJECTIVES: Determine the frequency of reversible airflow obstruction, and/or methacholine hyperreactivity during 2003 in a well-characterized population with a low-risk asthma diagnosis during 2001. METHODS: Of a total population of 7460 low-risk adult (18-64 years) asthma patients (no hospitalizations or emergency department visits; < 3 oral steroid courses; < 12 beta-agonist canisters; and < 3 prescibers, all in prior 12 months) cared for by a large health care program, a random sample of 400 was recruited to undergo a diagnostic asthma evaluation. The evaluation included a physical examination, medical record review, questionnaires, allergy testing, spirometry for airflow obstruction and reversibility, and/or methacholine hyperreactivity. RESULTS: Of the 400 randomly selected patients, 106 (26.5%) started and 82 (77.3%) completed the asthma evaluation. Evaluated subjects were predominately female (71%), middle-aged (mean 51.0 +/- 11.0 years), diagnosed asthmatics for long duration (mean 22.1 +/- 17.5 years), and nonsmokers (88.7%). Asthma was confirmed in 62.1% (51 of 82) based on a deltaFEV1 12% or greater after albuterol (n = 38), deltaFEV1 15% or greater after Advair (n = 6), or a positive methacholine challenge (n = 7). Only 35 of 400 patients (8.7%) ever had reversibility measured in their medical record. Of these, only 12 (34.3%) had a deltaFEV1 12% or greater after albuterol. Reversibility was confirmed in all six who had asthma evaluations. CONCLUSIONS: More than one third of low-risk adult asthmatics cannot be confirmed to have asthma 2 years later. Spirometry that documented reversibility in the medical record accurately predicted asthma confirmation. Physicians should more widely perform spirometry with reversibility to establish the diagnosis of asthma as recommended by national asthma guidelines.
