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Background Short-acting β -agonist (SABA) use is well established in predicting asthma events in adults. However, this predictive ability has yet to be established in a pediatric population together with an assessment of amount of use. Objective To identify the number of SABA canisters that best predicts future asthma-related exacerbations and the optimal length of time for measurement of SABA use in pediatric and adult asthma patients. Methods Asthma patients were identified from a Medicaid and a commercially insured database (January 1, 2004, through December 31, 2005, and January 1, 2004, through June 30, 2006, respectively). Following the date of first asthma medication, an assessment period (3, 6, or 12 months) was used to measure SABA use. Asthma-related exacerbations were identified in the subsequent 12-month period. Receiver operating characteristic curve analyses and logistic regression were used to select the critical values of SABA use and optimal assessment periods and to conduct incremental analysis, respectively. Results A total of 33,793 Medicaid and 101,437 commercial patients met the study criteria. Use of 3 or more SABA canisters during 12 months was identified in both pediatric Medicaid and commercial populations to best predict an increased risk of an asthma-related exacerbation. For adults, use of 2 or more SABA canisters was found as the critical value with shorter optimal assessment periods of 3 and 6 months. Each additional SABA canister resulted in an 8% to 14% and 14% to 18% increase in risk of an asthma-related exacerbation in children and adults, respectively. Conclusion The study identified critical values of SABA use that predict future asthma events. Each additional SABA canister predicted increases in exacerbation risk in children and adults.

Environmental control education is recommended for allergic patients with persistent asthma, but patients may not be willing to comply with recommendations. In a prior study from our group, only 24% of patients reported making any recommended environmental changes.To determine what environmental changes allergic asthmatic patients say they would be willing to make and what changes they actually make.Asthmatic patients with known perennial aeroallergen sensitization were asked by telephone to rate on a 1- to 5-point Likert scale their willingness to make specific environmental changes. Items with mean scores of 3 or higher were used to formulate a practical set of recommendations to be given to patients in stage 2 of the study. Stage 2 patients were given the advice formulated in stage 1 and then telephoned 2 months later to see what changes they actually made.Stage 1 patients (n = 60) were willing to institute 14 of the 18 proposed allergen-specific recommendations. Of 36 stage 2 patients who were allergic to mite, mold, and/or dander, 29 (80.6%) reported that they complied with at least 1 of the recommendations made in this study. Patients who owned their own home were significantly (P.05) more likely (91.3%) to make at least 1 change than patients who rented their home (63.6%).Pending additional information, we suggest that environmental control recommendations for mite, mold, and dander emphasize those used in this study because they appear to be practical for a substantial proportion of patients, especially if they own their home.

INTRODUCTION The Healthcare Effectiveness Data and Information Set (HEDIS) was developed by the National Committee for Quality Assurance and has been applied to many diseases, including asthma.1 The National Committee for Quality Assurance attempts to create and facilitate HEDIS measures that reflect “quality care” that then may be used to identify plans offering such quality care and to compare results among plans. The HEDIS asthma measure identifies patients with “persistent asthma” based on inpatient, outpatient, and pharmacy utilization data and assesses the proportion of such patients dispensed at least 1 controller medication. Problems with this measure include that this administrative definition of persistent asthma may not adequately reflect persistent asthma as defined clinically2,3 and that patients who meet these criteria for appropriate treatment may actually be at increased risk for subsequent emergency hospital care.4,5 Since 2005, 2 years of continuous enrollment and qualification as “persistent asthma” have been required to increase the specificity of the HEDIS denominator.1 However, health plans may prefer a measure that can be applied to members with a single year of continuous enrollment so as to maximize the number of patients who can be evaluated. A Joint Task Force of the American Academy of Allergy, Asthma and Immunology and the American College of Allergy, Asthma and Immunology was convened to study this subject. Working with pharmaceutical company collaborators, a study5 was performed in 4 different commercial insurance data sets to try to identify an improved asthma quality-of-care measure using administrative data. The strategy was to test the relationship of different numerator-denominator combinations of medical and pharmacy claims in year 1 to asthma exacerbations in the subsequent year. A measure associated with reduced exacerbations would presumably be a better measure of quality care than would a measure not associated with reduced exacerbations. The main findings of this previous study5 were as follows: 1. Based on the lowest number of patients, the highest prevalence of controller use, and the highest prevalence of exacerbations in patients not receiving controller medications, the diagnosis plus 4 medications denominator was the most specific of the 1-year denominators tested for persistent asthma. 2. Compared with other numerators tested, the ratio measure (ratio of controllers to total medications 0.5) was most consistently associated with improved outcomes in all age groups with the more specific denominators. However, the previous Task Force report5 did not evaluate close alternative denominators (eg, 1 encounter with an asthma diagnosis plus 3 medications or 2 encounters plus 2 medication dispensings). The purpose of the present study was to test several additional denominators to define the optimal 1-year denominator to be used with the ratio measure. The main characteristic of the denominator being sought was optimal discrimination of the ratio in predicting acute asthma episodes. Other aspects of the denominators that were evaluated included the size of the denominator and the proportion of patients with medication ratios of 0.5 or greater.

Background Rhinitis is a common health condition, but the extent of the burden in managed care organizations (MCOs) has not been well described. Objective To compare medical utilization in a large MCO of patients (1) with vs without rhinitis and (2) with allergic (AR) vs nonallergic (NAR) rhinitis. Methods Patients 4 years and older with 1 or more encounters with an International Classification of Diseases, Ninth Revision, code for rhinitis and patients treated for rhinitis but without a rhinitis encounter (rhinitis treatment-only group) were identified. Patients seen in allergy departments for rhinitis were categorized as having AR or NAR. Results Of 1,726,084 patients continuously enrolled for all 4 study years, 29% had 1 or more encounters for rhinitis (15%) or were treated for rhinitis (14%). Compared with patients without rhinitis, those with rhinitis encounters were significantly more likely to have encounters for asthma (odds ratio [OR], 2.7), acute sinusitis (OR, 4.4), chronic sinusitis (OR, 15.2), conjunctivitis (OR, 1.5), acute otitis media (OR, 1.9), chronic otitis media (OR, 4.3), sleep apnea (OR, 3.4), and fatigue (OR, 2.0). Results for rhinitis treatment-only patients (n = 242,565) were generally similar to those for rhinitis encounter patients. NAR was diagnosed in 21% of patients, who were significantly more likely than patients with AR to undergo sinus radiology and nasal surgery; to receive diagnoses of sinusitis, otitis media, sleep apnea, and fatigue; and to receive medications for nonrespiratory conditions ( P Conclusions Rhinitis was common in this large MCO. Patients with rhinitis, especially NAR, had significantly more respiratory and nonrespiratory comorbid conditions than did patients without rhinitis.