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HMOs should adjust their use of inhaled anti-inflammatory medicines for asthma patients to meet national guidelines

Asthma is the most common chronic disease among children and the most frequent reason for hospitalization. It is characterized by airway inflammation which, if untreated, may lead to permanent airway damage. Current asthma care guidelines recommend inhaled anti-inflammatory medications—such as corticosteroids and cromolyn—as first-line treatment.

Unfortunately, managed care organizations (MCOs) often do not dispense these controller medications, which have been associated with fewer asthma-related hospitalizations, to children who could benefit from them. In a recent study, only 39 percent of patients treated by three MCOs were given these controller medications. The study was conducted by the Pediatric Asthma Care Patient Outcomes Research Team (PORT), which is supported in part by the Agency for Healthcare Research and Quality (HS08368).

Researchers examined the claims and pharmacy databases of three MCOs for 13,352 children (3 to 15 years of age) who had an outpatient or emergency department visit or hospitalization for asthma in the previous year. Medications analyzed included inhaled and oral bronchodilators (that is, beta-agonists and anticholinergics), inhaled corticosteroids, inhaled cromolyn and nedocromil, oral theophylline, and oral steroids.

Less than 40 percent of children were given controllers during the 1-year period, with ranges of 15 to 77 percent by level of bronchodilator use, 31 to 44 percent by age, and 38 to 42 percent by MCO. The dispensing patterns of anti-inflammatory agents differed substantially among MCOs. Inhaled corticosteroids were given to 56 percent of patients in one MCO, compared with about 42 percent in the other MCOs. However, the other two MCOs were more likely than the first one to dispense cromolyn inhalers. The youngest children were least likely to receive controller medications. Rates of asthma hospitalizations and emergency department visits also differed among the MCOs, ranging from 21 to 37 per 1,000 person-years and 37 to 142 per 1,000 person-years, respectively.

See "Asthma pharmacotherapy and utilization by children in 3 managed care organizations," by James G. Donahue, Ph.D., Anne L. Fuhlbrigge, M.D., Jonathan A. Finkelstein, M.D., and others, in the December 2000 Journal of Allergy and Clinical Immunology 106, pp. 1108-1114.

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