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Chang Suk Noh, M.D.1, Jae Seung Lee, M.D.1, Jin Woo Song, M.D.1, 4, Tae-Bum Kim, M.D.2, 4, Nam Kug Kim, Ph.D.3, You Sook Cho, M.D.2, 4
, Sang-Do Lee, M.D.1, 4, Hee-Bom Moon, M.D.2, 4, Yeon-Mok Oh, M.D.1, 4
, Sang-Do Lee, M.D.1, 4, Hee-Bom Moon, M.D.2, 4, Yeon-Mok Oh, M.D.1, 4
Abstract
Background
Inhaled corticosteroids (ICSs) are the most essential medication for asthma control. Many reports suggest that the usage of ICSs improves not only the control of asthma symptoms but also prevents exacerbation. We investigated whether increases in ICS prescriptions are associated with decreases in asthma exacerbation in the clinical practice setting.
Methods
We retrospectively analyzed the database of adult asthma patients who had visited a tertiary referral hospital, the Asan Medical Center between January 2000 and December 2009. The number of emergency department (ED) visits, admissions, intensive care unit (ICU) care, deaths, and ICS prescriptions were analyzed to evaluate the time trend of asthma exacerbation as a function of the ICS prescription rate during the ten years.
Results
The numbers of ED visits, admissions, and episodes of ICU care decreased during the ten years (p<0.001, p=0.033, p=0.001, respectively) while the number of ICS prescriptions increased (p<0.001). We found a correlation between the number of ICS prescriptions and the number of ED visits, admissions, or ICU care. For these outcomes, the correlation coefficients were r=-0.952, p<0.001; r=-0.673, p=0.033; r=-0.948, p<0.001, respectively.
Conclusion
The number of ICS prescriptions increased during the past ten years while the number of asthma exacerbations decreased. Our results also showed a negative correlation between the ICS prescription rate and asthma exacerbation in the clinical practice setting. In other words, an increase in ICS prescription may be a major cause of a decrease in asthma exacerbations.
Figures and Tables
Figure 1
Annual change of ED visits (A), admission (B), ICU care (C), death (D), and ICS prescription (E) in asthma patients. *r2 and p-value were obtained by simple linear regression, †For adjustment, the numbers of ED visits, admission, ICU care, death, and ICS prescription were divided by the number of outpatient visits in each year. ED: emergency department; ICS: intensive care unit; ICS: inhaled corticosteroids.
Figure 2
Relationship between ICS prescription and ED visits (A), admission (B), ICU care (C), or death (D) in asthma patients. *Spearman's rho and p-value were obtained by Spearman's correlation, †For adjustment the numbers of ED visits, admission, ICU care, death, and ICS prescription were divided by the number of outpatient visits in each year. ED: emergency department; ICS: intensive care unit; ICS: inhaled corticosteroids.
Table 1
Annual characteristics of hospital visits in asthma patients of the Asan Medical Center
Values are presented as number (%) unless otherwise indicated.
*Values are mean±SD, †Represents death which was recorded only inside the Asan Medical Center, but not outside, ‡The number of prescriptions for inhaled corticosteroid.
ED: emergency department; ICU: intensive care unit; ICS: inhaled corticosteroids.
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