Assessing Future Need for Acute Care in Adult Asthmatics

To develop simple clinical tools predictive of acute asthma care and to identify modifiable risk factors. Prospective cohort study. A large health maintenance organization (430,000 members). Adult members (18 to 55 years old) with asthma. Data from a questionnaire, skin-prick testing for inhalant al...

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Veröffentlicht in:Chest 2007-10, Vol.132 (4), p.1151-1161
Hauptverfasser: Osborne, Molly L., Pedula, Kathryn L., O'Hollaren, Mark, Ettinger, Kenneth M., Stibolt, Thomas, Buist, A. Sonia, Vollmer, William M.
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container_end_page 1161
container_issue 4
container_start_page 1151
container_title Chest
container_volume 132
creator Osborne, Molly L.
Pedula, Kathryn L.
O'Hollaren, Mark
Ettinger, Kenneth M.
Stibolt, Thomas
Buist, A. Sonia
Vollmer, William M.
description To develop simple clinical tools predictive of acute asthma care and to identify modifiable risk factors. Prospective cohort study. A large health maintenance organization (430,000 members). Adult members (18 to 55 years old) with asthma. Data from a questionnaire, skin-prick testing for inhalant allergens, and spirometry were collected at the baseline visit. Acute care utilization data were obtained from administrative databases for a subsequent 30-month period. This two-phase study first identified and performed a split-sample validation on three clinical tools to determine their predictive ability by employing data from a questionnaire, questionnaire plus spirometry, and questionnaire plus spirometry and skin-prick testing. Second, it identified modifiable independent risk factors. The 554 study participants generated 173 episodes of acute care over 1,258 person-years of follow-up (0.14 episodes per person per year). Of these, 101 participants had at least one episode, and one third of this group had two or more episodes. Clinical scoring into risk groups was done by reverse stepwise regression analyses. Using relative risks (RRs) as a guide, high-risk, moderate-risk, and low-risk groups were identified. The high-risk groups, 13 to 21% of the validation sample, had a 7- to 11-fold increased risk for hospital care compared to the low-risk groups. The moderate-risk groups, 46 to 50% of the validation sample, had a twofold- to fourfold-increased risk. FEV1 was the most significant predictor (RR, 4.33). Of the four potentially modifiable risk factors identified, current cigarette smoke exposure (RR, 1.6) and ownership and skin-prick test positivity to cat or dog (RR, 1.5) were the most significant. These models stratify asthma patients at risk for acute care. Patients with lower FEV1 values are at significantly higher risk, underscoring the importance of spirometry in asthma care.
doi_str_mv 10.1378/chest.05-3084
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ispartof Chest, 2007-10, Vol.132 (4), p.1151-1161
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recordid cdi_crossref_primary_10_1378_chest_05_3084
source Alma/SFX Local Collection
subjects asthma
health maintenance organization
health-care utilization
spirometry
tobacco
title Assessing Future Need for Acute Care in Adult Asthmatics
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