ASSESSMENT OF AN AMBULATORY CARE ASTHMA PROGRAM

In response to rising asthma morbidity and mortality, numerous compreh ensive asthma programs have been developed. However, few studies have examined critically the effectiveness of such programs or the means by which treatment or outcome is altered. To assess the role of a specia lized ambulatory asthma care program, we reviewed the interventions re commended to 344 patients referred for the assessment of asthma. A sub set of 127 made return visits 6-12 months following their initial asse ssment, thereby allowing assessment of behavioral and physiological ou tcomes. At the initial consultation, the recommended medication change s were: inhaled beta-agonists + 6% (p < 0.01), inhaled steroids + 58% (p < 0.001), intranasal steroids + 8% (p < 0.001), dry powdered formul ations + 13% (p < 0.01), theophylline - 7% (p < 0.001). The percentage of patients using spacer devices increased 8% (p < 0.001). Comparing preassessment values to those at a visit at 6-12 months following asse ssment, a further 25% of patients taking inhaled steroids at the initi al assessment had a change to either the dose, device, or frequency of administration. Mean FEV(1) improved from 2.41 +/- 0.08 liters at the initial assessment to 2.64 +/- 0.09 liters at the 6- 12-month visit ( p < 0.001). There was an increase in the number of patients considered mild and not obstructed, with a corresponding decrease in the number considered moderately and severely obstructed (p < 0.05). The number o f emergency room visits was reduced by more than 60% (p < 0.001) in pa tients followed for at least 6 months. We conclude that an ambulatory asthma program marked by increased use of inhaled antiinflammatory med ications and decreased use of theophylline can produce significant dec reases in asthma exacerbations requiring hospital care, emergency room care, or systemic steroids while reducing the prevalence and severity of airflow limitation.