Impact of inhaled antiinflammatory therapy on hospitalization and emergency department visits for children with asthma

Objective. Although the efficacy of inhaled antiinflammatory effectiveness of these medications in real-world practice settings in reducing acute heal th care use has not been well-evaluated. This study examined the effect of inhaled antiinflammatory therapy on hospitalizations and emergency departme nt (ED) visits by children for asthma. Design. Defined population cohort study over 1 year. Setting. Three managed care organizations (MCOs) in Seattle, Boston, and Ch icago participating in the Pediatric Asthma Care-Patient Outcome Research a nd Treatment II trial. Participants. All 11 195 children, between 3 to 15 years old, with a diagno sis of asthma who were enrolled in the 3 MCOs between July 1996 and June 19 97. Outcome Measures. We identified children with 1 or more asthma diagnoses us ing automated encounter data. Medication dispensings were identified from a utomated pharmacy data. Multivariate logistic regression analysis was used to calculate effects of inhaled antiinflammatory therapy on the adjusted re lative risk (RR) for hospitalization and ED visits for asthma. Results. Over 12 months, 217 (1.9%) of children had an asthma hospitalizati on, and 757 (6.8%) had an ED visit. After adjustment for age, gender, MCO, and reliever dispensing, compared with children who did not receive control lers, the adjusted RRs for an ED visit were: children with any (greater tha n or equal to1) dispensing of cromolyn, 0.4 (95% confidence interval [CI]: 0.3, 0.5); any inhaled corticosteroid (ICS), 0.5 (95% CI: 0.4, 0.6); any cr omolyn or ICS combined (any controller), 0.4 (95% CI: 0.3, 0.5). For hospit alization, the adjusted RR for cromolyn was 0.6 (95% CI: 0.4, 0.9), for ICS 0.4 (95% CI: 0.3, 0.7), and for any controller 0.4 (95% CI: 0.3, 0.6). A s ignificant protective effect for both events was seen among children with 1 to 5 and with >5 antiinflammatory dispensings. When the analysis was strat ified by frequency of reliever dispensing, there was a significant protecti ve effect for controllers on ED visits for children with 1 to 5 and with >5 reliever dispensings and on the risk of hospitalization for children with >5 reliever dispensings. Conclusions. Inhaled antiinflammatory therapy is associated with a signific ant protective effect on the risk for hospitalization and ED visits in chil dren with asthma. Cromolyn and ICSs were associated with similar effects on risks.