Asthma, hospitalization rates

Asthma hospitalization rates were higher in rural (RR 3.13) than in urban areas (RR 2.79) Asthma prevalence (7.9% 95% Cl 7.73-8.08) was not statistically different... 

Asthma hospitalization rates were higher in rural than in urban areas. 

Fig. 1. Annual Seattle childhood asthma hospitalization rate.

The rapid increase in asthma hospitalizations of children in the U.S. as a whole and in Seattle can be reversed if the NHLBI guidelines for asthma are followed. A health maintenance organization (HMO) in Hawthorne, California reduced asthma hospitalization rates from 66 to 22 per 10,000 and the associated costs by 14% by having an allergist train their pediatricians (Jancin 1995), but one survey found that only 25% of the primary care physicians had adopted the NHLBI procedures for treating asthma (Jancin 1995). 

Determine the cause of the increase in asthma hospitalization rates of children in Seattle and the U.S. 

The addition of ipratropium bromide to inhaled p2-agonist therapy in acute severe asthma improves pulmonary function and decreases hospitalization rates in both adult and pediatric patients.31 The benefit of combining ipratropium and albuterol appears to be greatest in moderate to severe exacerbations, and the combination should be considered first-line therapy in severe exacerbations. 

In New Zealand, Ellison-Loschmann et al. (2004) observed regional patterns of asthma hospitalizations in Maori vs. non-Maori areas. The rate of asthma hospitalization was higher for Maori than for non-Maori peoples in two different age-groups 15-34 years RR=1.31 and 35-74 years RR=2.97. Moreover, the differences were higher in rural areas (RR 1.34 and 3.13) than in urban areas (RR 1.22 and 2.79) (Ellison-Loschmann et al. 2004). 

Rural areas had higher asthma hospital admission rates. 

Childhood asthma hospitalizations in Seattle rose from 306 in 1988 to 612 in 1993, an average increase of 14.4%/yr for children under 15 yr of age (WSDH 1994), compared with a 4%/yr increase in the U.S. as a whole. Asthma-related hospital costs in Seattle rose more than 300% in these same 6 years from 614,000 to 2,526,000. Seattle hospital rates were 56/10,000 in 1993 (Fig. 1) compared with 35/10,000 per year for the U.S. as a whole (NHLBI 1994a WSDH 1994). These rates were based on the 1990 census data, adjusted by using the Seattle public school (unpublished) population for October of each year. The average 1993 rates (90.8) in the four Seattle zip code areas with the most Medicaid cases averaged five times that (17.9) found in Redmond, a suburb of Seattle (WSDH 1994). Asthma is the leading cause of hospitalization of preschool children in Seattle and the leading cause of school absence in the U.S. (Batik et al. 1992 Pope et al. 1993). 

Levine M, Iliescu ME, Margellos-Anast H, Estar/iau M, Ansell DA. The effects of cocaine and heroin use on intubation rates and hospital utilization in patients with acute asthma exacerbations. Chest 2005 128(4) 1951-7. 

For clinical research purposes, subjective measures are used to evaluate the response to P2-agonists, including rescue use of these agents, symptom score, and asthma quality of life or health outcomes, such as rates of asthma-related emergency visit, hospitalization, and death. These subjective... 

Although both the prevalence and the morbidity from asthma are increasing, the death rate from asthma in the United States appears to have reached a plateau of about 5000 deaths per year and may be on the decline. Despite the relatively low number of asthma deaths, 80% to 90% are preventable. Most deaths from asthma occur outside the hospital, and death is rare after hospitalization. The most common cause of death from asthma is inadequate assessment of the severity of airways obstruction by the patient or physician and inadequate therapy. The most common cause of death in hospitalized patients is also inadequate or inappropriate therapy. Thus the key to prevention of death from asthma, as advocated by the NAEPP, is education. ... 

Rates of hospitalizations for asthma during this period nearly doubled for infants. Although some of this rise may be attributed to improved identification and surveillance, a greater proportion is attributable to the changing nature of the indoor envir-... 

I had never met either Jimmy (the six year old boy) or his mother (a single inner city teenage parent) before. His asthma attack was severe, his peak expiratory flow rate only 35 percent of normal. Twenty years ago my next steps would have been to begin bronchodilator treatment, call an ambulance, and send the boy to the hospital. That also would have been the story ten years ago, or five, or two. 

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