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Low-Dose Inhaled Corticosteroid Therapy and Risk of Emergency Department Visits for Asthma
Don D. Sin, MD, MPH;
S. F. Paul Man, MD
Arch Intern Med. 2002;162:1591-1595.
Background Patients who visit the emergency department (ED) because of asthma frequently
have a relapse. While the use of inhaled corticosteroids has been demonstrated
to improve asthma symptoms and lung function, it is not clear whether their
use after discharge from the ED reduces asthma relapse rates.
Objective To determine whether inhaled corticosteroid therapy reduces ED asthma
relapse rates.
Methods We analyzed ED visit and medication data on patients 5 to 60 years of
age who were enrolled in a government-sponsored drug plan and who visited
an ED because of asthma between April 1, 1997, and March 31, 1999, in Alberta,
Canada (N = 1293). Using a Cox proportional hazards model, we determined the
relative risk (RR) of relapse ED visits among users and nonusers of inhaled
corticosteroids after discharge from the ED. We also compared the RR of relapse
ED visits across different dose categories.
Results Users of inhaled corticosteroids after ED discharge had 45% fewer relapse
ED visits than did nonusers (adjusted RR, 0.55; 95% confidence interval [CI],
0.44-0.69). Low-, medium-, and high-dose therapies were associated with similar
reductions in the risk of relapse ED visits: low-dose therapy (RR, 0.52; 95%
CI, 0.39-0.68), medium-dose therapy (RR, 0.51; 95% CI, 0.34-0.76), and high-dose
therapy (RR, 0.67; 95% CI, 0.47-0.94).
Conclusions Inhaled corticosteroid therapy after ED discharge is associated with
a significant reduction in the risk of subsequent ED visits. Low-dose therapy
appears to be as effective as high-dose therapy. However, further studies
are needed to determine the optimal dosing regimen for inhaled corticosteroid
therapy for asthma.
From the Division of Pulmonary Medicine, University of Alberta (Drs
Sin and Man), and the Institute of Health Economics (Dr Sin), Edmonton, Alberta.
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