Treatment patterns for pediatric asthma prior to and after emergency department events

There are 2 million asthma-related emergency department (ED) events each year in the United States. Children share a disproportional burden of these events. This study was designed to describe the treatment patterns in children in the year prior to and 2 months after an ED event. This retrospective observational study utilized the PharMetrics Integrated Outcomes Database that contains administrative claims from over 20 managed-care plans across the United States. Children aged 1-17 years with at least one ED visit for asthma during 2001 were included. Patients were required to have data available 12 months prior to and 2 months following the ED visit. We identified 5,501 pediatric asthma-related ED admissions. In the year prior to the ED event, 19.4% of children received an inhaled corticosteroid (ICS), 31.4% an oral corticosteroid (OCS), and 58.3% a short-acting beta-agonist (SABA). Overall, there were 3.7 albuterol units for every ICS unit dispensed in the 12 months prior to the event. Ninety-four percent of the children had an office visit in the year prior to the ED visit. Prescriptions dispensed for ICS and OCS increased 2.9-fold and 8.2-fold, respectively, in the month after the ED event. However, the dispensing rates for both medications reverted to near baseline by the second month after the index event. In conclusion, this study demonstrates the dependence of children with asthma on the use of rescue medications. An ED event results in only an incremental and transient increase in ICS-containing controller treatment.