Asthma, Rhinitis, Other Respiratory DiseasesIntranasal steroids and the risk of emergency department visits for asthma☆,☆☆
Section snippets
Methods
All subjects were members of Harvard Pilgrim Health Care and received care at any one of 14 staff-model centers (now Harvard Vanguard Medical Associates) located in eastern Massachusetts. The MCO maintains computerized information systems that capture basic demographic data, medical records that include coded diagnoses, tests and procedures from each ambulatory encounter, and claims files for all hospitalizations and ED visits. Automated pharmacy records maintained by or available at all sites
Results
During the 3-year study period, 13,844 persons satisfied the eligibility criteria for asthma. The overall observation time was 40,402 person-years. The median duration of observation time was 3 years, and 75% of the study population were members of the MCO for at least 2.3 years. The mean age of the population was 26 years (SD, 17 years). The majority were adults, with 3888 aged between 6 and 17 years, 5134 aged between 18 and 34 years, and 4822 aged 35 years and older. Female patients
Discussion
These data suggest that treatment for upper airways diseases with nasal steroids and oral antihistamines is associated with a reduced frequency of asthma-related ED visits. The effect of treatment for the nose in reducing asthma-related ED visits was seen in persons who were also being treated with orally inhaled corticosteroids for asthma, as well as in those not using inhaled steroids. After controlling for asthma treatment and indicators of asthma care (routine and urgent ambulatory visits),
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Supported by Harvard Pilgrim Health Care Research Foundation. Dr Adams is a recipient of the Thoracic Society of Australia and New Zealand/Allen and Hanbury's Respiratory Research Fellowship. Dr Fuhlbrigge is supported by a Mentored Clinical Scientist Development Award (1 KO8 HL03919-01) from the National Heart, Lung, and Blood Institute.
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Reprint requests: Anne L. Fuhlbrigge, MD, MS, Channing Laboratory, Brigham and Women's Hospital, 181 Longwood Ave, Boston, MA 02115.