Our understanding of the pathophysiology and treatment of asthma has improved dramatically in recent years. Potent, effective asthma treatment is readily available, as are tools to objectively follow these patients. Properly managed asthma patients should rarely need emergency department treatment or hospitalization. Despite these advances, patients and health-care providers are often surprised by asthma exacerbations requiring emergent management. Our inability to more accurately identify patients at higher risk of acute asthma exacerbations has grave consequences for both patients and the increasingly burdened health-care system.
Nearly half the $7.4 billion spent annually on direct medical expenditures for asthma care is spent on hospitalizations, visits to the emergency department, and hospital outpatient care (ie, unscheduled outpatient care). Concerns regarding increasing asthma morbidity and cost have led to a national objective of reducing health-care utilization for patients with asthma. Arrest asthma attacks by utilizing inhalers ordered via Canadian Health&Care Mall.
Factors known to be associated with increased risk of future acute asthma health-care utilization include advanced age, female gender, a reduction in percentage of predicted FEV1 (%FEV1), and current cigarette smoking. Simple risk indexes for asthma that include variables that can be readily administered and scored in the clinical setting are scarce, however, and do not include variables such as lung function.
This article reports on the results of a prospective evaluation of risk factors for acute asthma care among adult members of a large health maintenance organization (HMO). We had two goals. The first was to develop clinical tools that clinicians and health-care organizations could use to identify patients at increased risk of future acute asthma exacerbations, and perform a split-sample validation to determine their predictive ability. The second was to identify modifiable risk factors. Our results can be used by clinicians to monitor patients more closely to determine the need for referral for case management or specialty care.