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Giving disadvantaged inner-city adults systemic corticosteroids after ED treatment for acute asthma may prevent relapses

Disadvantaged inner-city adults with poorly controlled asthma often end up in the emergency department (ED) or are hospitalized for acute asthma episodes. These same adults are prone to relapse for weeks following acute asthma treatment, which can lead to another hospital visit. A short course of oral corticosteroids (for example, prednisone) following ED treatment for an acute asthma episode may prevent these relapses, according to a recent study that was supported by the Agency for Healthcare Research and Quality (HS09461).

Yvonne M. Coyle, M.D., of the University of Texas Southwestern Medical Center, and her colleagues followed a group of 309 adults. Most of the subjects were black or Hispanic and had been discharged from a public hospital ED following acute asthma care between 1997 and 1999. The researchers identified which care processes were effective for improving peak expiratory flow rate (PEFR, strength of expiration, a key indicator of lung function in people with asthma) 2 to 3 weeks after ED discharge. After adjusting for known patient risk factors for lower PEFR (for example, smoking, upper respiratory tract infection in the past month, and indoor allergen exposure), they assessed the association between recommended acute asthma care processes (inhaled beta-agonists, inhaled corticosteroids, systemic corticosteroids, asthma care followup, and patient asthma education) and PEFR change between baseline (when they received acute asthma care) and followup.

Only the appropriate use of systemic corticosteroids at ED discharge had a significant effect on increasing the percentage change in PEFR at the 2- to 3-week followup. However, the appropriate use of all processes of acute asthma care was positively associated with an increase in the percentage change in PEFR.

More details are in "Effectiveness of acute asthma care among inner-city adults," by Dr. Coyle, Corinne C. Aragaki, Ph.D., Linda S. Hynan, Ph.D., and others, in the July 14, 2003, Archives of Internal Medicine 163, pp. 1591-1596.

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