OBJECTIVE
To assess the frequency and types of visits related to modifications in the intensity
of asthma medications.
PATIENTS AND METHODS
We retrospectively reviewed the medical records of adults (aged 18-40 years) and children
(aged 6-17 years) living in Olmsted County, Minnesota, to evaluate changes in asthma
medications by dose and drug class and site and type of visit (routine vs unscheduled)
at the time of changes. All records from all visits were reviewed for each patient
to identify asthma-related visits at all sites of care from January 1, 2002, through
December 31, 2003.
RESULTS
The study consisted of 397 adults and children. In 255 patients, 597 asthma medication
changes occurred. Step-up changes usually occurred because of an exacerbation or loss
of control of asthma and adhered to the medication hierarchy in the national asthma
guidelines. Twenty step-up changes involved skipping inhaled corticosteroid (ICS)
monotherapy and moving directly to combined ICSs plus a long-acting β-agonist (LABA).
Lack of documentation of asthma symptom frequency or interference with activities
made it impossible to determine whether these “skips” were appropriate. Only 78 physician-directed
step-down changes were documented, usually to a lower dose of combined ICSs and LABAs
or a move from combined ICSs and LABAs to anti-inflammatory monotherapy. Patients
initiated additional step-down changes between encounters. Step-down changes occurred
at routine or follow-up asthma visits, but the limited number of such visits provided
few opportunities for step-down care.
CONCLUSION
The continuing episodic-style treatment of asthma aimed at exacerbation management
facilitates step-up changes in asthma therapy. The dearth of asthma evaluation visits
limited opportunities to step down use of asthma medications and to provide long-term
asthma management.
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Article Info
Footnotes
Supported by an unrestricted grant from Integrated Therapeutics and grant AR30582 from the National Institutes of Health .
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© 2007 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
