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Poor asthma knowledge and exposure to indoor allergens complicate recovery after an acute asthma episode

Inner-city residents who are poor and have asthma are more likely than others with the condition to have uncontrolled asthma that prompts expensive and frightening emergency department (ED) visits and hospitalizations. Poor knowledge of asthma management and exposure to indoor allergens (known to worsen asthma) hinder their recovery after an acute asthma episode, according to a recent study led by Yvonne M. Coyle, M.D., of the University of Texas Southwestern Medical Center at Dallas.

In the study, which was supported by the Agency for Healthcare Research and Quality (HS09461), the researchers prospectively studied 309 adults, most of whom were poor and black, who were treated for acute asthma at a public hospital ED and then followed for 2 to 3 weeks. They assessed peak expiratory flow rate (PEFR), an indicator of breathing capacity at the time of the ED visit and at followup and the potential factors that predicted less improvement in the PEFR. These factors were smoking, upper respiratory infection, nonadherence to asthma medication, and indoor allergen and ozone exposure assessed over the 2-3 week followup, as well as lower asthma knowledge. With the exception of ozone exposure, these factors were assessed by patient questionnaire. The indoor allergen exposure was assessed by patient questionnaire and allergy skin testing.

The researchers examined which of these factors correlated with PEFR 2 to 3 weeks after ED treatment of the acute asthma episode, statistically adjusted for the patient's asthma severity, age, sex, and educational level. Greater asthma severity and being female were significantly correlated with less improvement in PEFR following the acute episode. Indoor allergen exposure and less asthma knowledge significantly predicted less improvement in PEFR, whether or not patients were treated with a course of systemic corticosteroids following the acute episode.

The findings from this study suggest that these patients need more than medication to treat an acute asthma episode. Asthma management typically requires patients to carry out complex medication regimens; use strategies to reduce or avoid indoor allergens such as dust mites, mold, tobacco smoke, cockroaches, and pet dander; detect and self-treat most asthma exacerbations (for example, monitoring the PEFR by blowing into a peak flow meter and adjusting asthma medication accordingly); and communicate effectively with their doctor.

Disadvantaged inner-city residents may lack the knowledge and motivation to adhere to such a complex process. They need interventions that target patient risk factors, indoor allergen exposure, and poor asthma knowledge in order to better manage their asthma and reap the most benefit from acute asthma care, concludes Dr. Coyle.

See "Predictors of short-term clinical response to acute asthma care in adults," by Dr. Coyle, Linda S. Hynan, Ph.D., Rebecca S. Gruchalla, M.D., Ph.D., and Ron J. Anderson, M.D., in the International Journal for Quality in Health Care 14(1), pp. 69-75, 2002.

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