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This Article Full Text (PDF) Free All Versions of this Article: chest.05-3084v1 chest.05-3084v2 132/4/1151    most recent Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to My Personal Article Archive Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Osborne, M. L. Articles by Vollmer, W. M. Search for Related Content PubMed PubMed Citation Articles by Osborne, M. L. Articles by Vollmer, W. M. Related Content Related Editorial

Predictors of acute care in adult asthmatics: A prospective HMO-based study

¹Oregon Health & Science University, Portland OR ²Center for Health Research, Kaiser Permanente Northwest, Portland OR ³The Allergy Clinic, Portland OR ⁴Kaiser Permanente Northwest

osbornem{at}ohsu.edu

Abstract

Study Objectives: To develop simple clinical tools predictive of acute asthma care and to identify modifiable risk factors.

Design: Prospective cohort study.

Setting: A large health maintenance organization (430,000 members).

Patients/participants. Adult (age 18-55) members with asthma.

Interventions: Data from a questionnaire, skin prick testing for inhalant allergens, and spirometry were collected at the baseline visit. Acute care utilization data were obtained from administrative databases for a subsequent 30-month period.

Methods: This two-phase study first identified and performed split sample validation on three clinical tools to determine their predictive ability by employing data from a questionnaire, questionnaire plus spirometry, and questionnaire plus spirometry and skin prick testing. Second, it identified modifiable independent risk factors.

Measurements and Results: The 554 study participants generated 173 episodes of acute care over 1258 person-years of follow-up (0.14 episodes per person per year). Of these, 101 participants had at least one episode, and one-third of this group had two or more episodes. Clinical scoring into risk groups was done by reverse stepwise regression analyses. Using relative risks as a guide, high-risk, moderate-risk, and low-risk groups were identified. The high-risk groups, 13-21% of the validation sample, were at 7- to 11-fold increased risk for hospital care compared to the low-risk groups. The moderate-risk groups, 46-50% of the validation sample, were at 2- to 4-fold increased risk. One-second forced expiratory volume (FEV₁) was the most significant predictor (relative risk [RR] 4.33). Of the four potentially modifiable risk factors identified, current cigarette smoke exposure (RR 1.6) and ownership and skin prick test positivity to cat or dog (RR 1.5) were the most significant.

Conclusions: These models stratify asthma patients at risk for acute care. Patients with lower FEV₁ values are at significantly higher risk, underscoring the importance of spirometry in asthma care.

Key Words: asthma • health care utilization • HMO • tobacco • spirometry

Related Editorial

Spirometry Enhances Identification of High-Risk Patients With Asthma

Homer Boushey and Paul Enright
Chest 2007 132: 1112-1113. [Full Text] [PDF]

This article has been cited by other articles:

				H. Boushey and P. Enright Spirometry Enhances Identification of High-Risk Patients With Asthma Chest, October 1, 2007; 132(4): 1112 - 1113. [Full Text] [PDF]