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Relationship Between Asthma Medication and Antibiotic Use^*

^* From the Clinical Effectiveness Program (Dr. Glauber), Children’s Hospital; Channing Laboratory (Drs. Fuhlbrigge and Weiss), Brigham and Women’s Hospital, Harvard Medical School; Department of Ambulatory Care and Prevention (Dr. Finkelstein), Harvard Medical School; and National Initiative on Children’s Healthcare Quality (Dr. Homer), Boston, MA.

Correspondence to: James H. Glauber, MD, MPH, Clinical Effectiveness Program, Children’s Hospital, Boston, Harvard Medical School, 333 Longwood Ave, Boston, MA 02115; e-mail: glauber{at}tch.harvard.edu

Study objectives: Increasing morbidity due to asthma and antimicrobial resistance among human pathogens are both major public-health concerns. Numerous studies describe the overuse of antibiotics in general populations and underuse of anti-inflammatory medications by asthmatic patients. However, little is known about the relationship between asthma medication and antibiotic use in asthmatics. Specifically, we tested the hypothesis that higher use of bronchodilator and anti-inflammatory medication by asthmatics, as a marker of problematic asthma, is associated with greater antibiotic use. We also test the hypothesis that physicians who are low prescribers of anti-inflammatory medications are high prescribers of antibiotics.

Design: We conducted a retrospective cohort study evaluating asthma medication and antibiotic use by children and adults with asthma and the prescribing of these medications by primary-care physicians.

Setting/patients: Subjects were continuously enrolled asthma patients aged 6 to 55 years receiving care in an urban, group-model, health maintenance organization.

Interventions: None.

Measurement and results: Main outcome measures were (1) antibiotic use by asthmatics stratified by low, moderate, and high bronchodilator use; (2) antibiotic use by asthmatics stratified by no, intermittent, and long-term anti-inflammatory use; and (3) correlation between physician-level anti-inflammatory agent to bronchodilator ratio (AIF:BD) and their rate of antibiotic prescribing. We found that (1) high bronchodilator users received 1.72 antibiotics per person-year (95% confidence interval [CI], 1.62 to 1.83), whereas low bronchodilator users received 1.23 antibiotics per person-year (95% CI, 1.19 to 1.27; p < 0.0001); (2) long-term users of anti-inflammatory agents received 1.85 antibiotics per person-year (95% CI, 1.76 to 1.95), whereas those not receiving an anti-inflammatory agent received 0.95 antibiotics per person-year (95% CI, 0.90 to 1.00; p < 0.0001); and (3) despite variations in physician AIF:BDs and antibiotic prescribing, respectively, these measures were not correlated.

Conclusions: Antibiotic use and asthma medication use are positively associated in a cohort of asthma patients. Greater effort is needed to define the appropriate role of antibiotics in asthma management.

Key Words: antibiotics • asthma • physician profiling

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