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Asthma patients with uncontrolled symptoms receive more antibiotics than those whose asthma is better controlled

A new study shows that people who have asthma with evidence of problematic symptom control, measured by use of asthma medication, receive more antibiotics than those with better control. Doctors may have lower thresholds for prescribing antibiotics for patients with more severe asthma. On the other hand, these patients may get more bacterial infections or have more severe symptoms than other asthma patients, prompting doctors to intervene with antibiotics, suggest the researchers. The appropriate role of antibiotics in asthma management remains to be defined, concludes the study's first author, James H. Glauber, M.D., M.P.H., of Children's Hospital.

In the study, which was supported in part by the Agency for Healthcare Research and Quality (National Research Service Award training grant T32 HS00063), Dr. Glauber and his colleagues evaluated asthma medication and antibiotic use by children and adults with asthma (aged 6 to 55 years) who received care in an urban health maintenance organization. Overall, 75 percent of asthma patients were prescribed an antibiotic during the study period, and they received an average of 1.3 antibiotic prescriptions per person-year.

Antibiotic use significantly increased with higher use of antiinflammatory and bronchodilator medications. Long-term users of antiinflammatory medications received almost twice as many antibiotics as those who did not receive an antiinflammatory prescription (1.85 vs. 0.95 antibiotic prescriptions/person-year). Similarly, patients with more symptomatic asthma, as evidenced by high levels of bronchodilator use (more than eight inhalers per year), received 40 percent more antibiotics than those whose bronchodilator use suggested intermittent problems with asthma (1.72 vs. 1.23 antibiotic prescriptions/person-year). There was no correlation between the overall number of bronchodilators or antiinflammatory medications prescribed by physicians and their rate of antibiotic prescribing.

See "Relation between asthma medication and antibiotic use," by Dr. Glauber, Anne L. Fuhlbrigge, M.D., M.S., Jonathan A. Finkelstein, M.D., M.P.H., and others, in the November 2001 Chest 120(5), pp. 1485-1492.

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