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Yvonne Marie Coyle, MD; Corinne Chie Aragaki, PhD; Linda Susan Hynan, PhD; Rebecca Sue Gruchalla, MD, PhD; David Ali Khan, MD

Arch Intern Med. 2003;163:1591-1596.

Background  Acute asthma often requires expensive emergency department visits and hospitalizations, especially among economically disadvantaged inner-city adults. However, few studies have examined approaches for improving acute asthma care in this population.

Methods  We conducted a cohort study involving patients who were discharged from a public hospital emergency department following acute asthma care between March 31, 1997, and August 5, 1999, to identify processes of care effective for improving peak expiratory flow rate at a 2- to 3-week follow-up. Adult patients who met the predetermined criteria for asthma, who underwent a baseline peak expiratory flow rate reading, and who did not have concurrent acute sinusitis or pneumonia were eligible (N = 448). Of the 365 patients enrolled in the study, 309 (84.7%) completed it. We used a multiple linear regression analysis adjusted for patient risk to assess the association between acute asthma care processes derived from the National Asthma Education Prevention Program guidelines (inhaled ₂-agonists, inhaled corticosteroids, systemic corticosteroids, asthma care follow-up, and patient asthma education) and percentage peak expiratory flow rate change at follow-up.

Results  Systemic corticosteroids had a significant effect for increasing percentage peak expiratory flow rate change at the 2- to 3-week follow-up for all asthma exacerbation severity levels ( = 26.1; 95% confidence interval, 1.8-50.5; P = .04) and severity levels specified by the National Asthma Education Prevention Program guidelines ( = 31.6; 95% confidence interval, 8.1-55.1; P = .01).

Conclusion  Outpatient systemic corticosteroids were effective for improving lung function 2 to 3 weeks after acute asthma care, and their use should reduce asthma-related morbidity, especially among economically disadvantaged inner-city adults.

From the Divisions of General Internal Medicine (Dr Coyle) and Allergy and Immunology (Drs Gruchalla and Khan), and Academic Computing Services–Biostatistics (Dr Hynan), The University of Texas Southwestern Medical Center at Dallas; and Division of Epidemiology and Biostatistics, The University of Texas-Houston School of Public Health (Dr Aragaki). The authors have no relevant financial interest in this article.

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