The JACI study is the largest of its kind to show the importance of an allergy specialist in the treatment of asthma. It is the first to explore the relationship between allergy specialty care, the dispensing of inhaled corticosteroids (IC), and the reduction of asthma related emergency room visits. Both adequate IC therapy (at least 4 canisters per year) and allergy specialty care are effective in preventing emergency hospital care for asthma. They have independent and additive effects in reducing emergency room visits for asthma.
Michael Schatz, MD, MS, FAAAAI, Kaiser-Permanente Medical Center, San Diego, and colleagues analyzed 9,608 asthma patients, ages 3-64 years, selected from the Southern California Kaiser-Permanente Asthma Case Identification Database. Baseline medication use, allergy specialty care and emergency room visits were looked at in 1999, and then compared to 2000 outcomes.
After analyzing the patients across the time points, researchers found:
- 27% of the patients receiving allergy specialty care resulted in reduced emergency room visits for asthma.
- Patients using four or more canisters/year of IC required less emergency room care for asthma, and those using seven or more were even less likely to require emergency room care for asthma.
- Patients receiving allergy specialty care were more likely to use seven or more canisters/year of IC.
- Patients receiving allergy specialty care and using seven or more canisters/year of IC had a greater reduction in emergency room visits for asthma.
Inhaled corticosteroids are recognized as the medications of choice for the treatment of chronic, persistent asthma by the National Asthma Education and Prevention Program (NAEPP) of the National Heart, Lung and Blood Institute (NHLBI). They are effective in reducing airway inflammation, hypersensitivity, swelling and mucous production. Increased prescribing of inhaled corticosteroids is an important component of the effect of allergist care on reducing emergency hospital use. Previous findings show that using six or more canisters of IC a year reduces death caused by asthma.
The study demonstrates that both adequate IC therapy and allergy specialty care are effective in preventing emergency room visits for asthma. The findings from the study also suggested that other aspects of allergy specialist care, such as patient education, environmental control, use of other medications and immunotherapy contribute to a reduction in emergency room visits as well.
Asthma is a chronic disease that affects more than 17 million people in the United States, accounting for $2.6 billion in hospitalizations and emergency room visits. The JACI study confirmed and extended previous findings showing that allergy specialty care reduces asthma hospitalizations, improves quality of life and reduces costs.
The AAAAI is the largest professional medical specialty organization in the United States representing allergists, asthma specialists, clinical immunologists, allied health professionals and others with a special interest in the research and treatment of allergic disease. Allergy/immunology specialists are pediatric or internal medicine physicians who have elected an additional two years of training to become specialized in the treatment of asthma, allergy and immunologic disease. Established in 1943, the Academy has nearly 6,000 members in the United States, Canada and 60 other countries. The Academy serves as an advocate to the public by providing educational information through its Web site at www.aaaai.org or the toll free physician referral and information line at 1-800-822-2762.
Journal
Journal of Allergy and Clinical Immunology