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Asthma symptom days determine annual costs of care for children with mild-to-moderate persistent asthma

The 1998 economic burden of asthma in the United States reached nearly $13 billion. For the large number of children with mild-to-moderate persistent asthma and normal or near-normal lung function, symptom days are predictive of health care costs, concludes a study supported in part by the Agency for Healthcare Research and Quality (HS08368). Symptom days include days when a child suffers from wheezing, coughing, nighttime awakening, or shortness of breath.

Researchers from the Pediatric Asthma Care PORT-II project (principal investigator Kevin B. Weiss, M.D., M.P.H., of Northwestern University) used medical records and missed parent workdays to determine asthma symptom burden and annual resource use for 638 children with mild-to-moderate persistent asthma in four managed care delivery systems in three U.S. geographic regions. They calculated how closely the percentage of predicted forced expiratory volume in 1 second (FEV1, force of expiration during spirometry, an indicator of lung function) and number of symptom days in the past 2 weeks were correlated with the costs of illness.

The median total annual asthma-related cost for the group was $564, with medicines accounting for nearly 53 percent of direct costs. After analyzing several variables, increasing asthma severity, use of peak expiratory flow meters, younger age, low-income status, minority race, and longer duration of asthma were significantly associated with increasing cost. Symptom days predicted annual costs better than percentage of predicted FEV1 in this group of children. This may be because most of the children in the study, despite some asthma symptoms, had normal or near-normal lung function (80 percent or better lung capacity), which is measured by FEV1. These findings support the association shown in other studies between increased asthma severity and increased asthma-related care costs.

More details are in "Resource costs for asthma-related care among pediatric patients in managed care," by Karna Gendo, M.D., Sean D. Sullivan, Ph.D., Paula Lozano, M.D., M.P.H., and others, in the September 2003 Annals of Allergy, Asthma, & Immunology 91, pp. 251-257.

Editor's Note: Another AHRQ-supported study (HS09123) on asthma in children reveals that parents evaluate their children's quality of life based on their emotional response to the family burdens related to the child's asthma rather than the child's asthma symptoms. For details, see Annett, R.D., Bender, B.G, DuHamel, T.R., and Lapidus, J. "Factors influencing parent reports on quality of life for children with asthma." Journal of Asthma 40(5), pp. 577-587, 2003.

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