Research Activities, May 2010: Emergency Medicine: Emergency department treatment of asthma with systemic corticosteroids is not always timely

Emergency Medicine
Emergency department treatment of asthma with systemic corticosteroids is not always timely

Each year, there are 2 million visits to emergency departments (EDs) for acute asthma attacks. Use of systemic corticosteroids (SCs) within 1 hour of ED arrival significantly improves pulmonary function and reduces the odds of hospital admission by 60 percent. However, not all asthma patients receive this treatment and, if they do, the medication may be given late in the course of the ED visit. The researchers identified 3,798 patients with acute asthma in 62 urban EDs located in 23 States. They analyzed clinical data to determine if patients had received SCs in a timely manner, specifically within 1 hour or less.

The majority of patients (67.4 percent) received SC treatment in the ED. However, more than half of treated patients (51.5 percent) got SCs more than an hour after their arrival time, with a median door-to-SC time of 62 minutes. ED physicians appropriately administered SCs to patients with more severe episodes (i.e., history of intubation for asthma, higher respiratory rate, and lower oxygen saturation). However, nonmedical factors associated with delayed SC treatment concerned the researchers. For example, patients with delayed SC treatment were more likely to be women, 40 years of age and older, and have a longer duration of symptoms.

Delayed patients also had longer ED stays and the likelihood of a delay in treatment was increased during peak ED hours. Patients who did not receive SCs were more likely to be discharged from the ED. The study was supported in part by the Agency for Healthcare Research and Quality (HS13099).

See “Factors associated with delayed use or nonuse of systemic corticosteroids in emergency department patients with acute asthma,” by Chu-Lin Tsai, M.D., Sc.D., Brian H. Rowe, M.D., MSc., Ashley F. Sullivan, M.S., M.P.H., and Carlos A. Camargo Jr., M.D., Dr.P.H., in the October 2009 Annals of Allergy, Asthma & Immunology 103, pp. 318-324.

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Research Activities, May 2010: Emergency Medicine: Emergency department treatment of asthma with systemic corticosteroids is not always timely

Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

Agency News and Notes
Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

The number of Americans under care for depression and other mental illnesses nearly doubled between 1996 and 2006, and the overall cost of treating them jumped by nearly two-thirds, according to the Agency for Healthcare Research and Quality. The Agency’s recent data analysis revealed that the number of patients treated for mental disorders, including depression and bipolar disease, increased from 19 million to 36 million. The overall treatment costs for mental disorders rose from $ 35 billion (in 2006 dollars) to nearly $ 58 billion, making it the costliest medical condition between 1996 and 2006. In addition, the study concluded that:

Heart disease, cancer, trauma-related disorders, and asthma joined mental disorders to comprise the five most costly conditions in both 1996 and 2006.
Overall spending for heart disease treatment increased the least, from $ 72 billion in 1996 to $ 78 billion in 2006.
Spending for cancer treatment went from $ 47 billion to $ 58 billion; asthma costs rose from $ 36 billion to $ 51 billion; and the cost to treat trauma-related disorders climbed from $ 46 billion to $ 68 billion.
In terms of average per-patient cost, cancer accounted for the highest, up slightly from $ 5,067 to $ 5,178, but treatment costs for trauma and asthma rose more steeply, increasing from $ 1,220 to $ 1,953 and from $ 863 to $ 1,059, respectively. In contrast, average per-patient spending for heart conditions and mental disorders fell from $ 4,333 to $ 3,964 and $ 1,825 to $ 1,591, respectively.
These findings were based on analysis of the Medical Expenditure Panel Survey (MEPS), a detailed source of information on the health services used by Americans, how often they are used, the cost of those services, and how they are paid. For more information, go to The Five Most Costly Conditions, 1996 and 2006: Estimates for the U.S. Civilian Noninstitionalized Population, at http://www.meps.ahrq.gov/mepsweb/data_stats/Pub_ProdResults_Details.jsp?pt=Statistical%20Brief&opt=2&id=910.

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Research Activities, November 2009: Agency News and Notes: Heart conditions, cancer, trauma-related disorders, mental disorders, and asthma were the five most costly conditions in 1996 and 2006

Research Activities, December 2011: Agency News and Notes: Children"s use of asthma controller drugs doubles

Children’s use of asthma controller drugs doubles
The proportion of children who used a prescribed controller drug to treat their asthma doubled from 29 percent in 1997–1998 to 58 percent in 2007–2008, according to the latest News and Numbers from the Agency for Healthcare Research and Quality (AHRQ). Asthma controller drugs, such as corticosteroids, control inflammation, thereby reducing the likelihood of airway spasms; asthma reliever drugs, such as short-acting beta-2-agonists, open up the airways to make breathing easier; and leukotrienes help prevent asthma symptoms from occurring.  

AHRQ also found that during the 1997–1998 and 2007–2008 timeframes:
•Use of inhaled corticosteroids, a type of controller drug, increased from 15.5 percent to 40 percent. Use of other controller drugs also increased: beta agonists (from 3 percent to 13 percent) and leukotrienes (from 3 percent to 34 percent).
•Use of reliever and oral corticosteroid drugs declined from 44 percent to 30 percent and from 17 percent to 9 percent, respectively.
•Average annual total spending for all asthma drugs more than quadrupled from $ 527 million to $ 2.5 billion.  Specifically, spending for controller drugs grew from $ 280 million to $ 2.1 billion and for reliever drugs, the increase was $ 222 million to $ 352 million (all in 2008 dollars).
•Spending for oral corticosteroids fell from $ 25 million to $ 8 million (2008 dollars).

The data in this AHRQ News and Numbers summary are taken from the Medical Expenditure Panel Survey, a detailed source of information on the health services used by Americans, the frequency with which they are used, the cost of those services, and how they are paid. For more information, view Statistical Brief #341: Changes in Children’s Use and Expenditures for Asthma Medications, United States, 1997-1998 to 2007-2008. 

For more information, contact Bob Isquith at bob.isquith@ahrq.hhs.gov or call (301) 427-1539.

Research Activities, December 2011: Agency News and Notes: Children’s use of asthma controller drugs doubles