CHANGES IN ASTHMA SEVERITY IN MANITOBA

Objective: To assess changes in the severity of physician-diagnosed as thma between 1983 and 1988. Design: Cross-sectional studies examining the frequency of markers of asthma severity: hospitalizations, ICU adm issions, hospital emergency department visits, multiple physician cont acts, and referrals to specialists in patients aged 0 to 14 years, 14 to 34 years, and greater than or equal to 35 years separately. Setting : Physicians' claims data from the universal Provincial Health Insuran ce Plan for fiscal years 1983 and 1988. Patients: All patients with th e diagnosis of asthma, bronchitis, and CORD identified from the Manito ba Health database. Measurements: The markers of severity were related to the prevalence of patients seeing a physician and receiving a diag nostic label of asthma, CORD, or bronchitis. Results: The number of pa tients with physician-diagnosed asthma increased by 36.4% over the 5 y ears. In 1983, 11% of asthmatics were hospitalized during the year and 8% were hospitalized in 1988 (-2.5%; 95% confidence interval [CI], -3 .2 to -1.8%). During both years, about 75% of the patients hospitalize d were in hospital once only. Mean and median duration of hospital sta y declined. The percentage of asthmatics seen in the hospital emergenc y departments declined slightly in all age groups, the total being 21% in 1983 and 18% in 1988 (-3.5%; 95% CI, -4.5 to -2.5%). About one thi rd of the patients with asthma were seen only once by a physician duri ng both of the years examined, 43 to 45% of them being seen on three o r more occasions during both years. Referrals to specialists for all a sthmatics increased from 12 to 14% (1.9%; 95% CI, 1.0 to 2.8%) from 19 83 to 1988. This was almost entirely due to an increase from 11 to 16% (5.1%; 95% CI, 4.0 to 6.2%) in the youngest age group, an increase no t accompanied by an increase in any other marker of severity. Changes in asthma severity were similar to changes in the severity in patients with bronchitis and COPD. Conclusion: No increase in severity of asth ma was seen between 1983 and 1988, but the prevalence of the diagnosti c label of asthma increased substantially.